Services Overview Holistic Treatments Hands & Feet Skin Care Body Care Products Overview Cleansers Toners Exfoliants Moisturisers Masques Concentrated Boosters Targeted Treatments Treatmnet Foundation Eye Treatments AGE Smart™ Daylight Defense System Body Therapy Daily Groomers Skin Kits
Services Overview
Holistic Treatments Hands & Feet Skin Care Body Care
Products Overview
Cleansers Toners Exfoliants Moisturisers Masques Concentrated Boosters Targeted Treatments Treatmnet Foundation Eye Treatments AGE Smart™ Daylight Defense System Body Therapy Daily Groomers Skin Kits
…. questionnaire! Please complete the form below so we can assess what products and services may be suitable for you. First Name Surname Email Telephone Your Health 1.) Have you seen a dermatologist or been under a physicians care within the last 12 months? If yes please give details 2.) Please mention past or current health problems? For example diabetes, epilepsy or surgery. 3.) Please list current medication prescribed or over the counter products. Your Skin Goals 4.) Do you have specific skin concerns? If so what are they? What do you want to achieve as a skin care goal? 5.) Have you had a chemical peel, microdermabrasion, or a skin resurfacing treatment? If yes please give details 6.) Do you use Accutane, Retin A or any other prescribed skin products? 7.) Do you ever experience these conditions on your skin? Tick all that apply Dryness Flakiness Obvious Dryness 8.) Do have a tendency to any of the following? Tick all that apply Burn Easily in Sunlight Blush Easily Tendency to Redness Sinus Problems 9.) Do you ever experience a burning, itching sensation on your skin? Yes No 10.) Please tick - do you experience an oily shine or experience skin breakouts Additional Info
Please complete the form below so we can assess what products and services may be suitable for you.
First Name Surname Email Telephone
Your Health
1.) Have you seen a dermatologist or been under a physicians care within the last 12 months? If yes please give details 2.) Please mention past or current health problems? For example diabetes, epilepsy or surgery. 3.) Please list current medication prescribed or over the counter products. Your Skin Goals
4.) Do you have specific skin concerns? If so what are they? What do you want to achieve as a skin care goal?
5.) Have you had a chemical peel, microdermabrasion, or a skin resurfacing treatment? If yes please give details 6.) Do you use Accutane, Retin A or any other prescribed skin products?
7.) Do you ever experience these conditions on your skin? Tick all that apply
Dryness Flakiness Obvious Dryness
8.) Do have a tendency to any of the following? Tick all that apply
Burn Easily in Sunlight Blush Easily Tendency to Redness Sinus Problems
9.) Do you ever experience a burning, itching sensation on your skin?
Yes No
10.) Please tick - do you experience an oily shine or experience skin breakouts
Additional Info
