• Date of Birth*
     - -
  • I am currently using or have used Accutane (isotretinoin) in the last six months*
  • I am pregnant or nursing/lactating*
  • I have allergies*
  • I have a skin infection/open wound in the treatment area*
  • I am allergic to aspirin (acetylsalicylic acid)*
  • I have been exposed to the sun or used a tanning bed in the last 3 weeks*
  • I am currently using sunless tanning products*
  • I am using any prescription or non-prescription retinoids (eg. retinol, Retin-A®, Tazorac®)*
  • I am using any prescription topical medications at this time*
  • I have used skincare products that caused an adverse reaction*
  • Which of these statements is most applicable to you?
  • Have you had an aesthetic consultation or treatment before?*
  • How often do you think about having an aesthetic treatment?*
  • When I think about my appearance, I feel I look..*
  • After treatment I would like to feel-Please tick three*
  • Which of these apply to your skin?*
  • Which of these in-clinic treatments interest you?*
  • How did you hear about us?*
  • Preferred contact details

  • If you would like to track your skin journey with before pictures, your skin therapist can take these for you in-clinic. 

    If you are doing a virtual skin consultation with us, taking pictures of your skin will allow us to learn more about your concerns and create a treatment plan and prescribe homecare that is tailored to you.

     

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