Name*
Address*
Date of Birth*
Telephone Number*
Email Address*
Please tick the appropriate box below
Are you currently taking any medication prescribed by a GP or any other practitioner? YesNo 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
Please tick the appropriate box(s) below
What is your skin type? Dry (Eg. Tight, dull & Flakey)Oily (Eg. Breakouts, Blackheads & Shiney)Combination (Eg. Dry Cheeks, Oily T-Zone)Normal (Eg. Balanced & Smooth)
What are your main skin concerns? Fine LinesWrinklesEnlarge PoresPigmentationAcneRedness RosaceaUneven Skin ToneScaring
Do you have a history of the following? SmokingSunbeds
How sensitive would skin be? MildModerateVery SensitiveNot Sensitive
Are your prone to or currently have the following? EczemaPsoriasisRosaceaHerpes Simplex
Do you get any of the following? Cystic AcneComedones/BlackheadsPustules/White HeadsOccasional SpotsHormonal BreakoutsNever Breakout
What products are you looking for (Or Recommended)? Environ
What is your current skincare routine? Please complete each below. Cleanse
Toner
Moisturer
Mask
Eye Cream
What are your skincare goals/what would you like to achieve?
Please upload an image for a member of our team to analyse your skin.
I agree I have given the correct information above.
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After sending the above form, you can book an appointment using next section.
When the booking has been made we will confirm your appointment by email.
#document 1 Rebook a previous appointment 1. Choose a service 2. Choose a time 3. Confirm My Booking History Facials Massage Eye Beauty Waxing Spray Tan Manicure Special Offers Online Skin Consultation Any Therapist €30.00 €30.00 Ciara €30.00 Claire €30.00 Natasha Book Now Pick Me Up Any Therapist €75.00 €75.00 Ciara €75.00 Claire €75.00 Natasha Book Now × Choose Options Choose from the following options Mini Facial Choose from the following options Eyebrow Shape & Tint Choose from the following options Mini Manicure
Online Skin Consultation
Pick Me Up
Choose from the following options
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