Questionnaire

First Name

Surname

Email Address

Mobile Number

Do you have Botox / Fillers or Other Injectables?

What products are you currently using on your skin?

Have you ever had Cosmetic Surgery? If yes please give details

Have you or are you undergoing any Laser Treatments? If yes please give details

Are you currently on any prescribed medications or topicals? If yes, please give details?

Do you have any hereditary health/skin conditions? If yes please give details

Pores

A - Invisible or fine B - visible but smooth C - large & visible D - N/A

Skin colour

A - Naturally darker than ethnic type B - Medium Skin tone for ethnic type C - Fair or Very Fair for ethnic type

Skin Texture

A - Dry or Very Dry B - Combination Skin C - Oily Skin

Main Skin Concern

A - Spots or Acne B - Hyperpigmentation, Uneven Skin tone or dullness C - Fine Lines or Wrinkles D - N/A

Tolerance to Sunshine

A - Burns easily B - Tans but don't burn C - Rarely tans and never burns

Trigger Factors

A - mental stress B - Excessive tea/coffee C - oily or spicy foods D - N/A

Other Skin Concerns

A - Blackheads B - Whiteheads C - Milia D - N/A

52 Blucher st, Birmingham, B1 1QU, West Midlands, UK

(M): 07877961434
Email: promo.isvaara@gmail.com

Opening Hours: Monday-Sunday 11:00 am – 18:00 pm

PS: Ladies Only