Online Consultation Form

There are many factors that influence the condition of your skin.

By completing this online skincare Analysis you will help us to assist you in determining your skin type, the condition of your skin and suggested home care products based on the accuracy of the information provided by you.

Let’s get started.

Online Skin Analysis Disclaimer:

The online skin analysis is a complimentary service that determines your skin type and suggested home care products based on the accuracy of the information provided by you. The outcome of the analysis and suggested products does not substitute the professional advice provided in clinic by a beauty therapist, aesthetician, dermatologist, physician or licensed professional and should be used and referred to as a guide only.
Any products purchased by you in response to the outcome of the questionnaire issued by Professional Skincare Onlines skin analysis is your responsibility irrespective of whether the products meet your expectations or not, therefore our standard refund and exchange policy applies.
I understand and accept these terms

Please give our International License Skincare Therapist 24 to 48 hours to get back to you with the outcome of your skincare analysis and your Skin Type.

* Indicates required field

Name *

First

Last

Email *

Select One *

Age Range *

Tick the most appropriate answer, I excercise *

Are you currently or have you ever used any prescription products like Retin- A, Roaccutane, Cortisone cream, Renova or Adapaline? No/ Yes If 'Yes', please specify: *

Have you undergone any surgery in the past 6 months? No/ Yes If yes, please specify *

Are you pregnant? No / Yes *

)If 'No', are you trying to get pregnant? No/ Yes *

Have you had a baby in the past six months? No/ Yes *

Are you in on a restricted diet? No/ Yes *

Rate your stress levels on a scale from 1 - 5 , 1 being low and 5 being high *

What skin product range are you currently using? *

Do you have any of these skin problems? *

If you suffer from Acne, how would you rate the condition.. *

Do you often experience itchiness, stinging or show signs of redness after the application of skin care product? No/ Yes *

If you are male do you experience sensitivity after shaving? Yes/ No *

Pic the correct keyword to go with you correct face zone and describe how your skin feels after cleansing and without putting/ *

Do you have any of the following health problems? Tick the appropriate boxes. *

What is the SPF of your sun protector? *

What is your main concern, please specify? *

What skintype would you classify your skin as? *

If other, please specify *

What is your prefer skin care range? *

Where did you hear about us? *

Skin Analysis Form *

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