ONLINE CONSULTATION

Online Consultation

If you require assistance with choosing the correct skin care regime, need information about your skin condition and health/lifestyle factors that can affect it, references for reading and alternative practitioners then this is for you.

The more information you can provide, the better! On completion you will be emailed an invoice for $99 which is payable prior to receiving an in depth consultation including topical home care prescription, this is redeemable on purchases made within 5 working days of payment.

All professional skin products are available for purchase via email.

Consultation payment is non transferable or refundable. Please allow up to 5 working days to receive your prescription.

* Indicates required field

Name *

First

Last

ADDRESS *

EMAIL ADDRESS *

CONTACT NUMBER *

D.O.B *

GENDER *

Medical Conditions, Medications and Allergies. Please list all - even if they don't seem relevant to skin. N/A if none *

Are you under a Dermatologist or specialists care? list condition and specialist *

list all current medications and supplements *

ARE YOU AWARE IF YOU HAVE ANY HORMONAL IMBALANCES OR GYNAECOLOGICAL ISSUES? *

Are you currently taking, or have you used any of these medications in the last 6 months? *

Have you had any of the following treatments in the last 6 months? *

Facial surgery (including cosmetic) Injectables (muscle relaxant, fillers, collagen stimulators) Skin needling (in clinic or home) IPL or laser Peels, microdermabrasion, dermaplane LED Light therapy Clinical facials None of the above

Please attach the following three images of your skin.
Ensure there is a plain background with clear lighting, ideally not using the 'selfie' camera on your phone, hair tied back if applicable. Clear photos with good lighting will ensure a more accurate skin analysis.

Front *

Max file size: 20MB

Left Profile *

Max file size: 20MB

Right Profile *

Max file size: 20MB

How would you best describe your skin? *

Relatively consistent year round, no real concerns. Not oily or greasy, skin can feel tight after cleansing prone to dry patches and occasional sensitivity and breakouts. Occasionally oily mainly through T-zone with blackheads, some enlarged pores and occasional breakouts. Some parts of your face can be dry or normal. Skin feels oily to touch especially at the end of the day, pores are visible and blackheads/breakouts are frequent. Reactive to products and treatments, gets red and irritated easily, flushing on cheeks and chin is common. Occasional breakouts on cheeks and nose. Sun exposed and pigmented. Some mottled pigment on forehead and cheeks. Showing ageing characteristics, lines present and feeling a lack of volume and elasticity. History of eczema or dermatitis.

In detail, tell me about your skin, your main concern and your skin goals. *

IN DETAIL, LIST YOUR CURRENT SKIN, MAKEUP AND HAIR PRODUCTS. *

Is there any other relevant information you can provide? *

I certify that the preceding personal, medical and skin history statements are true and correct. I have disclosed all medical conditions, medications and supplements. I am aware it is my responsibility to inform my Dermal Therapist of any change in medical conditions, medications or allergies. I understand that a thorough medical history is required to ensure my Therapist can provide an accurate analysis of my skin, failure to provide these details may affect desired outcomes. *

I have read an understand this statement.