1. Eligibility & Safety

• I am not allergic to Hydroquinone, Tretinoin, Desonide, Aloe, Vitamin E, Vitamin C, or common topical bases (e.g., propylene glycol, alcohols, parabens, fragrance). If I have allergies, I will list them during intake.
• I am not pregnant or breastfeeding, and I will inform my provider if I plan pregnancy.
• I confirm the treatment areas do not have open wounds, active infection, or severe irritation, and I will not apply the cream to such areas.

2. Medical History & Screening

• I will disclose any drug or topical product allergies.
• I will state my main goal (e.g., fade dark spots, even tone, brighten, texture), describe my current concerns (location, duration, possible triggers such as sun exposure, prior acne/melasma, hormones), and list the areas to treat (e.g., face, neck, décolletage, hands).
• I will upload a clear, well-lit photo of the affected skin area.

3. Prior/Current Skincare & Procedures

• I will report whether I previously used Hydroquinone, Tretinoin, or topical corticosteroids (with product, duration, side effects if any).
• I will report if I currently use other active skincare (e.g., benzoyl peroxide, AHAs/BHAs/glycolic/salicylic acid, other vitamin C serums, retinoids, steroids) or had recent peels/laser/microneedling/waxing (include dates if possible).
• I will list all medications and supplements I take (dose if known).
• I will disclose medical conditions affecting skin healing or pigment (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, history of vitiligo or unusual loss of skin color, keloid tendency).

4. How to Use & Key Precautions

• I understand Hydroquinone 4% is for targeted dark spots and time-limited use as directed; I will stop and seek care if unusual dark/blue-black patches or severe irritation occur.
• I understand Tretinoin 0.025% can increase photosensitivity; I will use daily broad-spectrum SPF 30+, limit UV exposure/tanning, and follow nighttime use as directed.
• I understand Desonide 0.05% (low-potency steroid) is for short-term, thin-layer use to reduce irritation; I will avoid prolonged/large-area use, occlusion, or use on infected skin unless directed.
• I will follow the application schedule/order provided (do not layer incompatible products unless instructed; avoid use on freshly treated/irritated skin; wash hands after application; avoid eyes/lips/mucosa).
• I will stop use and contact my provider if I experience severe irritation, swelling, blistering, rash, dizziness, or any unexpected reaction.

5. Identification & Confidentiality

• Uploading a valid government-issued photo ID is a legal requirement to verify my identity before the consultation can be completed.
• This verification complies with state and federal telemedicine regulations.
• My personal information and ID will be handled securely, stored confidentially, and never shared except as required by law or to provide my medical care.

IMPORTANT: Please keep a clear image of your Driver’s License / State ID / Passport (or photo of any government-issued ID) ready on this device to upload.

6. How the Medication is Provided

• I understand this medication may be compounded using USP-grade ingredients by a licensed pharmacy; my instructions (amount/frequency/duration) will be individualized.

7. Consent

• I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense this compounded cream based on the information I have provided.

8. Payments & Refund Policy

• All purchases and services are final and non-refundable.

9. Policies

• I have read and agree to the Terms & Conditions, Privacy Policy, and Refund & Cancellation Policy.