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Healthy skin begins with Healthy cells. Our products provide the skin with the essential requirements that it needs to replace lost moisture, repair damage, improve cell renewal and protect from environmental stress. 

 

Consultation Questionnaire

Fill in your details to send your skin consultation direct to our skin care expert Noele Hammett. Please allow 72 hours for reply.

Name:
Surname:
Email:
Age:



HEALTH
Are you under the doctor/physician or dermatologist?
YesNo

Are you on any Medication?
YesNo

Have you had a recent course of Antibiotics? (last 3 months)
YesNo

Do you use Retin A, Renova, Adapalene, Cortisone, Benzoyl peroxide or any other medically prescribed skin products in the last 3 months?
YesNo

Have you taken Accutane or isotretinoin within the last 6-12 months?
YesNo

Have you received chemotherapy within the last 6-12 weeks?
YesNo

Do you have Diabetes?
YesNo

Do you have any thyroid conditions?
YesNo



HORMONES
Menstruation
YesNo

Puberty
YesNo

Pregnancy & Breast feeding
YesNo

Menopause
YesNo

Hormone replacement
YesNo

Contraceptive Pill
YesNo

Do you suffer from any known allergies?
FoodPollenMedicineFragranceAnimalsIodineother



LIFESTYLE


SUN EXPOSURE
Do you exposure your skin to ULTRA VIOLET LIGHT?
Including sun-bed use, holiday sun, outdoor activities.
YesNo

Do you exposure you skin to BLUE LIGHT?
What is Blue Light?
Blue light is produced naturally by the sun and generated by computer monitors, smart phone screens and other digital devices. Typically any unnatural light source.
YesNo



STRESS
What is your current level of stress?
HighMediumLow



ALCOHOL
Do you drink more than 6-8 units of ALCOHOL per week?
YesNo



CAFFIENE
Do you drink more than 4 caffeinated beverages daily?
YesNo



SMOKING
Do you smoke?
YesNo



POLLUTION
Do you live in a polluted area? Do you commute to work in the city?
YesNo



SLEEP
Do you sleep between 6-8 hours per night?
YesNo



NUTRITION
Do you follow a restricted diet?
YesNo



HYDRATION
Are you drinking 1 litre+ of water daily?
YesNo



CLIMATE
What is the current climate in your environment?
Hot & HumidCold & DryAir conditioning or HeatingNormal



EXERCISE
Do you part-take in regular exercise?
YesNo



YOUR SKIN


INFLAMMATION (PART 1)
Do you suffer from any of the following skin conditions?

Rosacea
YesNo

Eczema/Dermatitis
YesNo

Acne
YesNo

Psoriasis
YesNo



INFLAMMATION (PART 2)
Do you experience any of the following skin concerns?
FlushingPricklingBurningItchingRednessHea



TEXTURE
Do you experience any of the following skin concerns?
DrynessTightnessFlakingRough textureFine linesDull complexityThirsty



OIL PRODUCTION
Do you experience any of the following skin concerns?
Oily/ShineBreakoutsPustules/PapulesCysts/nodulesBlackheads/ComedonesScarring



AGEING
Do you experience any of the following skin concerns?
Loss toneLines & WrinklesPigmentationAge spotsThickening



YOUR CURRENT SKINCARE ROUTINE
Are you currently using products containing?
Glycolic acidSalicylic AcidLactic AcidVitamin A (eg retinol)Benzol Peroxideother Acids



SKIN PROCEDURES
Have you had any of the following procedures in the last 12 weeks?
SurgeryLaserChemical peelsMicrodermabrasionBotox & FillersBurns, including sunburnWaxingOther





THANK YOU

Thank you for taking the time to get to know your skin and understand the impact that your health, lifestyle and wellbeing has on its behaviour. I recommend you review your Skin Consultation every 12 weeks.

The Skin is smarter than we give it credit for. It has the ability to protect, renew and repair without the use of skincare. It is the lifestyle in which we live that causes our skin to need external support by using Science to provide an environment in which the skin’s natural Eco-system can be protected.

The most important decision is finding a skincare brand that you trust will deliver you a consistent, safe, stable products. I know there is so much choice out there for you. I promise to give you the best that science and quality has to offer in the industry. I have been passionately committed to helping people with their skin concerns for over 26 years. I will literally use every ounce of my knowledge and care to get you the results you search for.

Wishing you success on your journey for healthy skin.

Sincerely