Duac gel

Has your GP previously diagnosed you with acne?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you have any allergies to clindamycin, lindomycin or benzyl peroxide?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Are you pregnant, breast feeding or expecting to become pregnant while taking this medication?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you have acute porphyria?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Are you taking any of the following medication?*

Yes
No

Clindamycin;
Linomycin;
Benzoyl peroxide;
Tetracycline antibiotics (such as Oxytetracycline, Lymecycline or Minocycline);
Other antibiotics such as Erythromycin, Tretinoin, isotretinoin and tazarotene; neostigmine or pyridostigmine;
Oral Typhoid vaccine

We are unable to supply you with medication for acne. Please consult your GP.

Do you understand that this treatment can take at least 4-8 weeks before you see any improvement?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you understand that treatment should not be continued for more than 12 weeks?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you understand that if your condition worsens or you develop scarring you should stop treatment and consult your GP?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you understand that if you experience any erythema (severe redness), itching, burning or drying of the affected area you should stop treatment and consult your GP as soon as possible?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you understand that this treatment may increase your sensitivity to sunlight or sun beds and prolonged exposure to sun or UV light should be avoided and sun-cream should be used if exposed?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you understand that if you experience prolonged episodes of diarrhoea treatment should be stopped immediately and you should consult your GP?*

Yes
No

We are unable to supply you with medication for acne. Please consult your GP.

Do you agree to the following?*

Yes
No

I will read the patient information leaflet and all information on the product page before taking this medication.

This treatment is solely for my own use.

You will contact us and inform your GP if you experience any side effects with this medication.

I agree to the terms and conditions of this website

I confirm that all the information I have provided on this questionnaire is truthful and accurate.

You understand that prescribing decisions taken by our doctors relies on you answering any questions fully and truthfully and any incorrect information could be harmful to your health.

We are unable to supply you with medication for acne. Please consult your GP.

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