Medical intake
IncompleteStill needed: Full name · Date of birth · Gender · Allergies (write “None known” if none) · Current medications (write “None” if none) · Emergency contact name · Emergency contact phone · Phone or address. Your doctors see incomplete intakes flagged.
Personal
Contact
Phone or address is required — the clinic must be able to reach you. Doctors see these masked unless they reveal them with a recorded reason.
Emergency contact
Medical history
Lifestyle
Insurance (optional)
Consent — what each use is for
Care delivery not granted required for care
Your clinic uses your details, visits and photos to deliver your treatment. Withdrawing needs a clinic visit — care cannot continue without it.
Photo analysis not granted
Let automatic measurements (density, redness, coverage) run on your photos. Revoking stops future analysis; photos already taken stay as your care record.
Reminders not granted
Appointment and dose reminders. Revoke anytime; care continues unchanged.
Research not granted
De-identified use of your data in treatment research. Never sold, never identifiable. Revoke anytime.
Withdrawing care delivery needs a clinic visit. Every grant and withdrawal is recorded with its version.