REMOTE SKIN CONSULTATION

Full Name

Phone Number

email

Upload a clear photo in good lighting of the area of concern and without makeup on

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Tell us what you would like:

Tell us what you would like

Your skin concern / what you would like to improve?

Your current skincare product regime

Any medications you are taking

Any Allergies

Any medical history including if you are currently pregnant or breast feeding

I confirm that I am over 18

I confirm that I am over 18 and Agree to terms & conditions

Days

Hours

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