Welcome to our online rosacea assessment form

You will be required to take photos of your skin for your skin analysis.

If you are not on a mobile device with a camera, please switch to one now and proceed to the following website

www.dermatology.melbourne/rosaceacheck

Are you pregnant? *

YesNo

How far along are you in your pregnancy? *

Are you breastfeeding? *

YesNo

Are you planning a pregnancy in the next 12 months? *

YesNo

Please verify with your mobile number.

Send code

A confirmation code will be sent to your mobile device.

Let's get started and learn about your skin!

Skin colour and sun reactivity

Please tell us which one of the categories you fall into.

Skin characteristics

Please tell us which one of the categories you fall into regarding your skin type and sensitivity.

Normal Skin

Oily Skin

Dry Skin

Combination Skin

Great job! We're getting there!

Now that we have learnt a little about your skin, let's learn more about your rosacea!

Have you been diagnosed with rosacea by a GP or Dermatologist? *

Do you have sensitive skin? *

Do you flush or blush easily? *

Please describe what triggers you to blush or flush

Do your eyes ever feel gritty like they have sand stuck in them? *

Do you develop pimples on your nose and cheeks? *

A few more questions about your rosacea

When did you first have any problems with rosacea? *

Has your rosacea been stable, improving or worsening over this time? *

Have you ever seen a GP regarding your rosacea? *

YesNo

Have you ever seen a dermatologist regarding your rosacea? *

YesNo

When did you last see a dermatologist and what were the recommendations and your response to the treatments? *

Time to take some photos!

Tips for taking good photos:

1. Have someone else take photos for you if possible.

2. Take photos in bright lighting, facing a window or outside under daylight if possible.

3. Keep your phone straight and steady, not on an angle or whilst you are moving.

4. Make sure you get your entire head in the photos, not just one area of your face.

5. Make sure that there are no shadows in the photo.

6, Double check that your photos are in focus before moving on

Please take a front-on photo of your face *

Browse

Please take a photo of the right side of your face *

Browse

Please take a photo of the left side of your face *

Browse

What current treatments are you using for your rosacea?

Please list your current skincare regimen including tablets, creams, washes, lasers/peels or lifestyle changes. Please ensure you indicate which treatment you like or think is beneficial, if at all. *

Let's consider what you have tried IN THE PAST

Please list previous treatments you have tried in the past including skincare, tablets or laser including the number or length of treatments and whether you found them helpful or if you developed any unwanted reactions. *

Do you have any allergies? *

YesNo

Please list your allergies here *

Is there anything else you would like to tell us about you, your skin, your rosacea or your health? *

YesNo

Please tell us more! *

Great job! We are all done!

I confirm that all the information I have provided is true and accurate *

What happens from here?

Once you complete your details on the following screen, one of our specialist team members will call you with further recommendations.

Please Confirm Your Details

This is not the same as a medicare card.

I have read and understood the privacy policy *

I provide consent to be contacted by phone, SMS or e-mail. *