What bothers you most about your skin?
(Check all that apply)
When did you first start noticing your skin issues?
Back
What’s your age?
Did you know? Loss of collagen and skin elasticity ACCELERATES after the age of 35
The Good News: DRMA is designed to slow down the effects of skin aging and rejuvenate your skin at the cellular level
What products have you tried in the past or do you currently use?
(Select all that apply)
DRMA Helps Rebuild Collagen for Smoother, Tighter, Younger-Looking Skin
Your DRMA cream is made with FDA-approved, prescription-strength ingredients customized just for your skin. It helps rebuild collagen, tighten your skin, and give you a more youthful appearance.
How would you describe your current skincare routine?
Your Skin Needs ACTIVE Ingredients for Real Changes to Happen…
Most women don’t realize their skin changes rapidly alongside hormonal changes as we age. This is why you need clinical-level support!
DRMA contains doctor-prescribed doses of active skincare ingredients – the type you will never find in department stores or drugstores.
Now that we know a little more about your skin concerns...
Let’s connect you to a Licensed Dermatologist!
Which state do you reside in?
Congrats! You qualify for a FREE DRMA Virtual Consultation
Please create an account so your doctor can communicate with you easily:
Enter your phone number
(Your dermatologist will send prescription details to this number)
What sex were you assigned at birth?
(We formulate specific formulas for male & female skin types)
Are you currently pregnant, breastfeeding, or planning to become pregnant in the next 3 to 6 months?
What areas of the body are most affected?
How long have you had these concerns?
Have you experienced any of the following symptoms alongside your skin concerns?
Have you used any of the following for your skin concerns?
Please share any side effects you experienced with any of these products. If no side effects, indicate “None”
Do you have a preferred prescription strength?
Do you have any diagnosed medical conditions?
Please describe your medical conditions and timeline
Do you take any prescribed medications or over the counter supplements?
(we need to consider any drug interactions even with topical medication)
Please list all medications you are taking
Do you have any known allergies or intolerances to any foods, dyes, medications, antibiotics, or anything else?
Please share allergies and intolerances
How long ago was your most recent check up with a physician? We do recommend that our patients have a primary healthcare provider that they see in person on regular basis. If you do not have a primary healthcare provider, you can visit Zocdoc or search federally qualified health centers to find one in your area.
Thank You! Your DRMA Intake is Complete
Next Step: Message Your Dermatologist.
We’ve matched you to a doctor. Please ask any questions you have or share more details they should know that weren’t already covered.
As a reminder, you will not be able to edit your answers after this page
Parental Consent
Phone Number
Gender
Medical History
Please acknowledge that you understand and agree to the following: I have filled out a medical intake form that will be used by a board certified physician that is licensed in my state to make a medical treatment plan for me. I understand all the questions that have been asked of me. The information that I have provided is accurate and complete. I am the patient who is consenting to be evaluated for treatment and I consent to receiving care via telemedicine.
I acknowledge and agree to the above.
Thousands of women in their 40s have turned their skin around with DRMA ...and are surprised how easy it was to achieve younger-looking skin!
…and are surprised how easy it was to achieve younger-looking skin!
