Online Skin Consultation

Online Skin ConsultationWojciech Lecki2020-11-26T22:31:30+00:00

Online Skin Consultation

Please fill out our skin consultation form. We will also need a photo of your skin. Cost of this consultation is €30 and it is fully redeemable against our treatments or products.

To pay for the consultation you need to add it to your basket by clicking the button bellow.

Skin Consultation

First Name *

Last Name *

Your Phone Number *

Your Email Address *

Your Address *

Your date of birth *

Are you currently taking any medication prescribed by a GP or any other practitioner? *

Yes

Are you currently taking any medication containing vitamin A? *

Yes

Are you currently pregnant, planning pregnancy or breastfeeding? *

Yes

Are you attending any GP or other practitioner for any other conditions? *

Yes

Do you have any allergies? E.g. Aspirin, allergies to ingredients in products? *

Yes

What is your Skin type? *

Dry (e.g. tight, dull & flakey)

Oily (e.g. breakouts, blackheads & shiney)

Combination (e.g. Dry cheeks, Oily T-zone)

Normal (e.g. balanced and smooth)

Do you have a history of the following? *

Smoking

Sunbeds

How sensitive would skin be? *

Mild

Moderate

Very Sensitive

Not Sensitive

Are your prone to or currently have the following? *

Eczema

Psoriasis

Rosacea

Herpes Simplex

Upload image of your skin. *

Choose File

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Yes

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