My Care Mobile

Black Skin Acne KYC Pre Consulting Form

My Care mobile collects this KYC information to know a little more about you to help start a conversation with you when they contact you to help book your consultation and decide on your Acne Care Plan

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Name *

First

Last

Date Of Birth *

Gender *

Numbers in Birth

Numbers [Whatsapp Preferred] *

Email *

Location *

Marital Status *

How long have you been experiencing acne? *

less than 6 months
6 months to 1 year
1-3 years

Where do you mostly have acne? *

Face
Chest
Body
Other

Have you ever receive acne treatment before? *

Are you interested in receiving acne treatment online via Mycaremobile?

Yes
No
Maybe

How did you hear about the black Skin Acne Campaign?

Social Media
Friend or Family
Other

Providing trusted telemedicine services across Africa and beyond, focusing on acne care, skin health, and accessible healthcare for all.

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Contact

📞 +233 (0) 552 200 777 (Ghana HQ)

✉️ support@mycaremobile.com

This Site Is Not A Part Of The Google OR Facebook Website Or Meta Inc. Additionally, This Site Is NOT Endorsed By Google OR Facebook In Any Way. FACEBOOK Is A Trademark Of META, Inc.

Disclaimer: MyCareMobile provides telemedicine services across multiple regions. Services are subject to local regulations, and availability may vary by country. Always consult with a licensed medical professional before starting any treatment.