Consultation Form

Here at The Skin Company we understand how confusing it can be choosing the right products for your skin. Whatever your concerns there's no need to stress, we offer personal prescriptions designed to improve the quality of your skin. Simply complete the following questionnaire and leave the rest to us. With all our knowledge and expertise about your skin we will select the most appropriate products to give you the best results.

Consultation Form
Select any of the following that apply to your skin:
Acne
Occasional spots
Oily skin
Sensitive skin
Rosacea
Sundamage
Pigmentation
Broken capillaries
Fine lines
Loss of elasticity
Cellulite
Crapey eyes
 Blackheads
Enlarged pores
Combination
Dry/Flakey skin
Dehydration
Sun Spots
Thin skin
Scarring
Wrinkles
Sagging
Stretch Marks
Under eye dark shadows
Areas of Concern:
Eyes
T-zone
Nose
Bottom
Tummy
Hands
Back
 Neck
Cheeks
Whole face
Legs
Bust
Feet
Arms
Skin tone:
Light/white
Olive
Reddish
Light brown
 Pale/white
Medium
Black
Hair colour:
Blonde
Light brown
Silver
 Red
Black
White
Please answer Yes or No:
Are you pregnant? Yes / No
Do you smoke? Yes / No
Do you use a suncreen? Yes / No
Do you use sunbeds? Yes / No
Is there a history of skin cancer in your family? Yes / No
Skin Allergies? Yes / No
Do you have chemical peels? Yes / No
Facial surgery/Laser? Yes / No
IPL/Laser hair removal? Yes / No
Using glycolic/AHA products? Yes / No
Using Retinova/Accutane? Yes / No
Current skin care routine:
Current medication:
Describe your skin:
What would you like to change about your skin?
Your e-mail address: