Skin Consultation

    Personal Details


    Medical Consent

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    Are you currently taking any medication prescribed by a GP or any other practitioner?
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    If yes please please provide further information
    Are you currently taking any medication containing vitamin A?
    YesNo
    If yes please please provide further information
    Are you currently pregnant, planning pregnancy or breastfeeding?
    YesNo
    If yes please please provide further information
    Are you attending any GP or other practitioner for any other conditions?
    YesNo
    If yes please please provide further information
    Do you have any allergies? E.g. Aspirin, allergies to ingredients in products?
    YesNo
    If yes please please provide further information


    Skin Questionaire

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    What is your skin type?
    What are your main skin concerns?
    Do you have a history of the following?
    How sensitive would skin be?
    Are your prone to or currently have the following?
    Do you get any of the following?
    What products are you looking for (Or Recommended)?
    What is your current skincare routine? Please complete each below.


    Images of skin
    Please upload an image for a member of our team to analyse your skin.


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