YOUR SKINCARE CONSULTATION
Before we start your skincare consultation, we need to know if you currently live in the UK and that you are happy for us to hold onto your health data. We promise to look after it.
I currently live in the UK and agree to Uncouth holding my health data.
I am 16 or over
existing customer?
If you've already registered, login here. Filling this form in twice is silly.
for you
Already used to a certain strength of formula - we'll ask about this at the end of this consultation.
start date
Don't want to start right now ... pick a start date that works for you!
What would you like us to sort?
Hyperpigmentation & Melasma Bespoke Formulations including tretinoin, hydroquinone & more
Just glow me up!Bespoke Formulations
a picture tells a thousand words
Add three photos at the end of the consultation. Or upload later if you’re out and about but we'll need these in order to prescribe.
If you had to choose one for us to focus on the most?
Acne
Oiliness
Uneven texture
Enlarged pores
Anti-ageing
Rosacea
Hyperpigmentation
Just glow me up!
What was your sex at birth?
We're not being uncouth! We just need to know if there is a chance you could become pregnant. We appreciate that the gender you identify as may be different.
Male
Female
What is your date of birth?
You have to be 16 or above to use our service. Please make sure you give us the correct date of birth as we need this for your prescription.
Which areas of your face are affected?
Forehead
Nose
Cheeks
Chin
Jawline
Which of these pictures is closest to your acne?
Mild - I only get a few spots and/ or whiteheads and blackheads
Moderate - I get quite a lot of spots and they can become inflamed
Severe - I suffer from extensive spots and cysts
Do your spots leave you with uneven skin tone (dark or red marks)?
Yes
No
Not Sure
Do you suffer with acne scars?
Yes
No
Not Sure
Do you experience hormonal breakouts (an increase in spots around the time of your period)?
Yes
No
Not applicable
Don't know
Do you feel that your face looks red, more so than other people's?
Yes
No
Do you often experience facial flushing, for example after drinking alcohol or when stressed?
Yes
No
Do you suffer with spots?
Yes
No
Some people with rosacea experience dry eyes. Does this sound like you?
Yes
No
Have you used any steroid creams on your skin in the last 4 weeks?
Sometimes steroid creams can cause a rash similar to rosacea
Yes
No
Do you suffer with lupus?
Yes
No
Do you have any of the following symptoms - persistent diarrhoea, wheezing, abdominal pain?
Yes
No
Tick any of the below that apply to you
I would like to improve fine lines
I would like to improve my skin's elasticity and/or firmness
I would like my skin to look brighter
I would like to improve sun damage
I want to focus on prevention of skin ageing
Would you like us to treat any areas of pigmentation?
By pigmentation, we mean dark spots, freckles or melasma.
Yes
No
Not Sure
We understand you want your skin to glow! Do any of the below apply to you?
You can tick more than one
I'd like to improve the appearance of fine lines
I'd like to improve my skin's elasticity/ make it look more firm
I'd like to even out my skin tone
None of the above - just more glow please!
How would you describe your skin tone?
Pale, white skin. Always burns, never tans.
Fair skin. Usually burns, rarely tans.
Darker white skin. Tans gradually, sometimes burns.
Light brown skin. Rarely burns, tans with ease.
Brown skin. Very rarely burns, tans very easily.
Dark brown, black skin. Never burns, tans very easily.
Which areas of your face are affected by hyperpigmentation?
You can tick more than once
Forehead
Nose
Cheeks
Chin
Jawline
Do you know what the cause of your hyperpigmentation is?
Common types of hyperpigmentation are dark marks secondary to acne, larger dark patches secondary to melasma or secondary to ageing or sun exposure (sun spots, background freckling)
Yes, dark marks secondary to acne
Yes, melasma
Yes most likely secondary to ageing
Unsure
Are you suffering with active acne?
It is important we get your acne under control as well as treating your hyperpigmentation.
Yes
No
Sometimes large pores go hand in hand with blemish prone skin. How often do you suffer with spots?
Not very often
I get occasional breakouts
I suffer with a lot of spots
Which areas of your face are affected by oiliness?
You can tick more than once
Forehead
Nose
Cheeks
Chin
Jawline
Some people find that their skin is oily around their T-zone (central face) but can be dry in other parts of their face.
Yes, this sounds like me
No, it's mostly oily
Which of the below is most applicable?
I rarely suffer with spots
I get occasional spots
I suffer from frequent breakouts
Which areas of your face are affected by uneven texture?
You can tick more than once
Forehead
Nose
Cheeks
Chin
Jawline
Does the skin on your face feel rough, bumpy or flaky?
Yes
No
Sometimes
Not Sure
Do you suffer with spots?
Yes, mainly blackheads and whiteheads
Yes, I get a few inflamed spots
Yes, I get lots of spots
No
Which of the following best describes your skin?
Oily
Dry
Combination
Normal
Not Sure
Would you describe your skin as sensitive?
Does it easily react to skincare products?
Yes
No
Not Sure
Do you have any other active skin conditions affecting your face?
By this we mean conditions like eczema, psoriasis, lupus or skin cancer
Yes
No
Are you currently pregnant, breastfeeding or planning on becoming pregnant in the near future?
We need to know because some prescription ingredients shouldn't be used in pregnancy or whilst breastfeeding.
Yes, I'm pregnant
Yes, I'm breastfeeding
Yes, I'm planning to conceive
No, none of the above
Disclaimer
Some ingredients shouldn't be used when you are pregnant or breastfeeding (such as tretinoin, adapalene, hydroquinone, spironolactone and certain types of topical and oral antibiotics). The good news is we have some very effective topical formulas that are considered safe to use in pregnancy and when breastfeeding. At Uncouth, we ensure that this is highlighted to our medical team and that you receive a doctor approved, pregnancy safe formula that is also suitable to use when breastfeeding.
I have read the above information and am happy to go ahead
Have you used any prescription creams in the last 3 months?
Yes
No
Which prescription creams have you used?
Tick any that apply
Tretinoin (e.g Retin A or other personalised formulas)
Hydroquinone creams
Tretinoin + Clindamycin (Treclin)
Erythromycin + Zinc Acetate (Zineryt)
Benzoyl Peroxide + Clindamycin (Duac)
Isotretinoin gel (Isotrex)
Adapalene (Differin)
Azelaic acid (e.g Finacea, Skinoren or other personalised formulas)
Metronidazole (Rozex, Metrogel)
Ivermectin (Soolantra)
A steroid cream
Adapalene + Benzoyl Peroxide (Epiduo)
None of the above
Disclaimer
We would not advise doubling up on prescription treatments. If you are still using a prescription cream or creams and would like to use our treatment instead, we would suggest checking with your original prescriber to ensure that you are ok to switch!
I have read the above information and am happy to go ahead
Are you currently using Tretinoin?
Yes
No
What strength of Tretinoin have you used?
0.009%
0.015%
0.025%
0.05%
0.1%
Not Sure
Did you tolerate this strength?
Yes and I was using it every night
Yes, but only if I used it intermittently
No, it was too strong
Not Sure
Have you taken any prescription tablet medications for your skin?
Like oral antibiotics, isotretinoin (Roaccutane) or spironolactone
Yes
No
Have you used any of the below prescription tablets in the last three months?
Tick any that apply
Isotretinoin (Roaccutane) tablets
Tetracycline
Minocycline
Lymecycline
Oxytetracycline
Doxycycline
Trimethoprim
Erythromycin
Spironolactone
The contraceptive pill
None of the above
Did Isotretinoin (Roaccutane) tablets help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Isotretinoin (Roaccutane) tablets?
Yes
No
How long ago did you use Isotretinoin (Roaccutane) tablets?
I am taking it now
Less than 3 months ago
Over three months ago
Did Tetracycline help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Tetracycline?
Yes
No
How long ago did you use Tetracycline?
I am taking it now
Less than 3 months ago
Over three months ago
Did Minocycline help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Minocycline?
Yes
No
How long ago did you use Minocycline?
I am taking it now
Less than 3 months ago
Over three months ago
Did Lymecycline help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Lymecycline?
Yes
No
How long ago did you use Lymecycline?
I am taking it now
Less than 3 months ago
Over three months ago
Did Oxytetracycline help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Oxytetracycline?
Yes
No
How long ago did you use Oxytetracycline?
I am taking it now
Less than 3 months ago
Over three months ago
Did Doxycycline help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Doxycycline?
Yes
No
How long ago did you use Doxycycline?
I am taking it now
Less than 3 months ago
Over three months ago
Did Trimethoprim help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Trimethoprim?
Yes
No
How long ago did you use Trimethoprim?
I am taking it now
Less than 3 months ago
Over three months ago
Did Erythromycin help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Erythromycin?
Yes
No
How long ago did you use Erythromycin?
I am taking it now
Less than 3 months ago
Over three months ago
Did Spironolactone help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with Spironolactone?
Yes
No
How long ago did you use Spironolactone?
I am taking it now
Less than 3 months ago
Over three months ago
Did the contraceptive pill help your skin?
Yes
No
Not Sure
Did you experience any significant side effects with the contraceptive pill?
Yes
No
How long ago did you use the contraceptive pill?
I am taking it now
Less than 3 months ago
Over three months ago
Do you have any medical conditions?
It’s important we know if you have any medical issues such as heart, kidney or liver disease
Kidney disease
Heart disease
Liver disease
Anything else
No
Do you take any regular medications?
It’s important we know if you are on any regular medications including any supplements
Yes
No
Do you have any allergies that we should be aware of?
Yes
No
We want to know if you have any allergies to prescription medications or prescription creams. You can find a list of the base ingredients in our creams on our ingredient list. None of our prescription products contain fragrance.
Ingredient list for base creams that don't contain Spironolactone:
Aloe Barbadensis leaf juice | C 13-14 Isoparaffin | Caprylic Trigylceride | Deionized water | Laureth-7 | Phenoxyethanol | Polyacrylamide | Tocopheryl Acetate | Triethylene Glycol
Ingredient list for base creams that contain Spironolactone:
Aloe Barbadensis leaf juice | Cyclopentasiloxane | Disodium EDTA | Emulsifying Wax | Ethylhexylglycerin | Ethylhexyl Stearate | Glycerin | Phenoxyethanol | Sorbitol | Tocopheryl Acetate | Water
What do you use in your current skincare routine?
Cleanser
Moisturiser
Exfoliants (e.g glycolic or lactic acid)
A non prescription retinoid (e.g retinol / retinal)
None of these
Do you use an SPF as part of your daily skin routine?
Yes
No
Disclaimer
We'd recommend you always use a high protection SpF (30 or above) as part of your daily skincare routine.
This is even more important when you start using your custom formula because some of our active ingredients can make your skin more sensitive to the sun.I have read the above information and am happy to go ahead
DO YOU HAVE A PREFERENCE FOR YOUR INGREDIENTS?
We still need to review your consultation and photos so we can make sure we prescribe you the best treatment but it's helpful to know if there is a treatment option you would prefer.
No, I'm new to all of this. I'm happy for my dermatology team to decide
Yes, I do
ASSESSING YOUR ANSWERS
Checking which formulas you may be eligible for
'Fantastic customer service'
Liza Taylor
'I love the texture of my formula'
Jackie Crawford
Do you have a preference for the strength of tretinoin?
We'd always recommend starting low and building up but we understand you may have used tretinoin before.
Your prescriber may increment the strength of your next formula as part of your treatment plan. If you’d like on the same strength you can control this within your dashboard.No, I'm happy for the uncouth dermatology team to decide.
Tretinoin 0.015%
Tretinoin 0.025%
Tretinoin 0.05%
Tretinoin 0.1%
Is there anything else you would like our dermatology team to know?
Do you have any alergies or intolerances?
Tretinoin
Azelaic acid
Niacinamide
Hyaluronic acid
Adapalene
Clindamycin
Tranexamic acid
Azelaic
Hydroquinone
Spironolactone
Ivermectin
Metronidazole
Doxycycline
Erythromycin
Lymecycline
Hydrocortisone
Trifarotene
Tirzepatide
Semaglutide
If yes, please provide details. Or, do you have a particular preference for one of our active ingredients?
We can't make any promises but we will do our best to accommodate!
Disclaimer
I understand that Uncouth's medical team use this information to determine the safest and most appropriate treatment. If certain medical questions have been answered incorrectly it could have a negative impact on my skin and/or my health.
Uncouth creates personalised prescription creams which fall under the definition of unlicensed medications. Certain treatments may be used off-licence for the treatment of acne or rosacea.
I understand that Uncouth does not screen for any skin cancers.
I understand that my prescription formula is for my own use only and I will read the patient information leaflet supplied with my medication. I will inform Uncouth and my GP if I experience any significant side effects of treatment, if I develop a new medical condition or if I start a new medication.I will read the patient information leaflet supplied with my medication and have read the information above.
Do you have a treatment preference?
Dr. Emma Horton
Uncouth Founder & CEO
If you have any preferences, it would be helpful to know before our dermatology team reviews your photographs and consultation to make the final decision.
If applicable, you can select both creams and tablets.
CLARITY
Tretinoin 0.015-0.1% / Clindamycin 1% / Tranexamic 5%£48.40 for 30mls (refill every 2 months)
SOOTHE
Ivermectin 1% / Niacinamide 4% / Azelaic acid 10%£48.40 for 30mls (refill every 2 months)
BOOST
Tretinoin 0.015-0.1% / Azelaic Acid 4% / Niacinamide 4% / Hyaluronic acid 0.25%£48.40 for 30mls (refill every 2 months)
TRANSFORM
Tretinoin 0.025% / Hydroquinone 6% / Hydrocortisone 1%£48.40 for 30mls (refill every 2 months)
TRANSFORM +
Tretinoin 0.025% / Hydroquinone 8% / Hydrocortisone 1%£48.40 for 30mls (refill every 2 months)
BRIGHTEN
Tretinoin 0.015-0.1% / Azelaic acid 4% / Tranexamic acid 5% / Hyaluronic acid 0.25%£48.40 for 30mls (refill every 2 months)
REJUVENATE
Adapalene 0.3% / Niacinamide 4% / Hyaluronic acid 0.25%£48.40 for 30mls (refill every 2 months)
SERENITY
Spironolactone 5% / Tranexamic acid 4%Spironolactone Formulas are £59.99 for 15mls (refill every 1 month)
THE HORMONAL ACNE PILL
Pairs well with CLARITY, SERENITY OR BOOSTOral Spironolactone
£60 for a 3 month course.
THE ACNE PILL
Pairs well with REJUVENATEDoxycycline Antibiotic Tablets
£35 for a 3 month course.
THE ACNE PILL
Pairs well with BOOSTErythromycin Antibiotic Tablets
£35 for a 3 month course.
THE ACNE PILL
Pairs well with BOOSTLymecycline Antibiotic Tablets
£45 for a 3 month course.
THE ROSACEA PILL
Pairs well with SOOTHESlow Release Doxycycline
£80 for a 3 month course.
Let my dermatology team decide
Need help?
Email us on enquiries@uncouthskincare.co.uk
Which formula would you prefer?
Dr. Emma Horton
Uncouth Founder & CEO
We’re always transparent about our formulations. If you have any preferences, it would be helpful to know before our dermatology team reviews your photographs and consultation to make the final decision.
Heads up, our dermatology team will have the final say
Tretinoin / Tranexamic / Azelaic
Adapalene / Clindamycin / Niacinamide
Spironolactone / Tranexamic
Topical spironolactone can be prescribed if other topical acne treatments have been ineffective.
Spironolactone formulas are £59.99 for 15mls, expiry 1 month.*Let my dermatology team decide
Do you have a formula preference?
Heads up, our dermatology team will have the final say
Tretinoin / Azelaic Acid / Niacinamide / Hyaluronic acid
Tretinoin / Azelaic acid / Tranexamic acid / Hyaluronic acid
Let my dermatology team decide
Dark Spot Formula (hydroquinone 6%) can be added at checkout
Hydroquinone cream should be limited to 3-4 months of use at a time, followed by a three-month break.
Do you want us to consider you for dark spot formula?
Dark spot formula is hydroquinone cream 6%*
Yes
No
I'd like dark spot formula on its own
Let my dermatology team decide
Anything else?
Is there anything else we should know before writing your prescription? For example tell us the strength you’d prefer to start on if you haven’t already*
*Tretinoin strengths:
0.015%, 0.025%, 0.05%, 0.1%
Hydroquinone formulas are available in tretinoin strength 0.025%.
Prescription subject to dermatological assessment.
Would you like us to tell your GP about any treatment we give you?
Yes
No
Have you had a routine blood test recently and were they normal?
This doesn’t necessarily preclude you from treatment but it’s useful for our prescribers to know.
Yes - they were normal
Yes - they were abnormal
No
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