Consultation Form Please give as much detail where possible to help us advise.
You will receive your Personal Treatment Plan within 48hrs of us receiving your completed form.
Personal Details:
Skin Description (Type, Colour & Characteristics): Please tick where appropriate White - Always Burn, Never Tan, Blue Eyes, Blond or Red Hair
White - Usually Burn, Sometimes Tan, Light Skin and Hair
White - Sometimes Burn, Tan, Medium Skin Colour
Olive - Rarely Burn, Tan Well, Brown Eyes, Darker Skin
Brown - Rarely Burn, Deeply Tan
Black - Never Burn, Deep Pigmentation, Brown Eyes
Type:
Breakouts:
Sensitivity:
Skin History Please tick where appropriate
Prone: Details (Please state area)
Treatments (Past & Present) Details (Please state date of treatments areas)
Current skincare regime? Details
General Health Please tick where appropriate Details (Please state areas)
Concerns, Expectations & Additional Information Details
Declaration
By ticking the box below, I acknowledge that the above information is correct and I am aware that no warranty or guarantee is given regarding the result of any treatment or the products used in such treatment. I declare that the information I’ve provided is accurate & complete
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