Consultation Online Skin Consultation A skin consultation with a skin specialist is key when it comes to finding a skincare programme to suit you. No two skins are the same so a tailor made programme will deliver the best results. This is done to give both a professional consultation and recommendation but to also ascertain your own concerns and goals for your skin. We truly believe in the importance of the right daily home care routine and will spend time making sure your plan is bespoke to your skin. Discover radiant, younger-looking skin with a holistic approach to our consultations. FEED, FORTIFY & FINISH IS OUR MOTTO. Feed the skin with vitamin-rich nutritional supplements from Advanced Nutrition Programme. Fortify supports skin health using our Cosmeceutical skin care line Ultraceuticals. Finish protects and gives the complexion a luminous look with pure mineral makeup that is good for the skin. The consultation is free of charge and will include an in-depth skin analysis, homecare product and treatment recommendations. Personal Details Name * First Last * Last Email * Phone * Enter you date of birth : Please select your current level of stress on a level from 1-10: 1 2 3 4 5 6 7 8 9 10 Please tick your normal Level of Stress 1 2 3 4 5 6 7 8 9 10 How many ounces of water do you drink per day? Do you take supplements/vitamins? Yes No If you are taking any supplements/vitamins, please provide details. Are you currently taking any medication prescribed by a GP or any other practitioner? * Yes No Do you exercise? Yes No Do you use a daily environmental protection product (e.g. sunblock)? Are you currently taking any medication containing vitamin A? * Yes No If you are currently talking medication containing Vitamin A, please provide further information. Are you currently pregnant, planning pregnancy or breastfeeding? * Yes No If you are currently pregnant, planning pregnancy or breastfeeding, please provide further details. Do you have any allergies? E.g. Aspirin, allergies to ingredients in products? * Yes No If you do have any allergies, please provide information. 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 Lines Wrinkles Enlarged Pores Pigmentation Acne Redness Rosacea Uneven Skin Tone Do you have a history of the following? * Smoking Sunbeds No How sensitive would your skin be? * Mild Moderate Very sensitive Not sensitive Are your prone to or currently have the following? * Eczema Psoriasis Rosacea Herpes Simplex None Do you get any of the following? * Comedones/Blackheads Pustules/White Heads Cystic Acne Occasional Spots Hormonal Breakouts Never Breakout What is your current skincare routine? Please complete each below. Cleanse * Toner * Moisturizer * Mask * Eye cream * What makeup brand are you currently using? Would you be interested in learning more about how mineral make up can help your skin? * Yes No What are your skincare goals/what would you like to achieve? * Images of skin Please upload three clear images of your face profile, front left and right for our team to analyze your skin and you skincare recommendations. Front Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Right side Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Left side Drop a file here or click to upload Choose File Maximum upload size: 134.22MB * I agree I have given the correct information above. Are you attending any GP or other practitioner for any other conditions?* Yes No * By using this form you agree with the storage and handling of your data by this website. * If you are human, leave this field blank. Submit
