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    • About you
    • Your concerns
    • Your skin goals
    • Other

    1. Personal details:

    MaleFemale 18-2930-3940-4950-5960 +

    2. Choose your skin type:

    Very fair – burns instantly in the sunFair – blue eyes, burns easily, tans poorlyFair but tansOlive/Mediterranean – tans easilyBlack

    3. How would you describe the overall condition of your skin?

    Dry – skin feels tight and rough in texture, can be flaky and sometimes soreOily – skin feels more greasy, can look shiny, may suffer with some breakouts and open poresCombination – greasy on the t-zone and dry on the cheeksNormal – skin doesn’t feel overly dry or oily, feels comfortableNone of the above

    4. Do you experience any of the following concerns?

    Dryness – tight, flaky, dullAcne – breakouts, inflamed spots, redness, congestion/blackheadsOily – open pores, shiny skin, congestionRosacea or redness – sensitivity, skin can feel sore and uncomfortableAgeing – skin laxity, fine lines and wrinklesUneven skin tone – pigmentation, hyperpigmentation, skin damageNone of the above/other

    5. Please describe your daily skincare routine and your current skin care products you are using?

    6. What are your top 3 skin concerns?

    7. What are your skin care goals and what would you like to achieve?

    8. How much do you spend on skin care products?

    I don’t mind, quality is more important then priceI prefer to use mid priced productsI prefer to use low priced products

    9. More information:

    10. Upload an image: (optional)

    11. Contact details: