Please  fill out the form below so our dermatologist would know how best to serve you.

How would you describe your skin most of the time?

• Balanced. (Your skin tends to be not too dry and not too oily, with no strong sensitivity.)
• Dry. (Your skin might feel rough/tight, flake or become itchy, especially in colder weather.)
• Oily. (Your skin produces lots of natural oil, often giving you a shiny complexion )
• Combination. (Your skin is dry in some areas and oily in others, often the nose, chin and forehead.)

How sensitive is your skin?

• Not sensitive - I rarely react to any skincare products
• Sensitive - My skin sometimes reacts to skincare products
• Very sensitive - My skin usually reacts to skincare products

Other areas of concern

• Dark spots (hyperpigmentation)
• Wrinkles

Which of these pictures best depicts your acne?

• Inflamed spots (red or swollen or pus-filled)
• Non-inflamed spots (blackheads and whiteheads)

Do you have any discolouration (hyperpigmentation) that remains after acne spots have healed which can last for weeks or months?

• Yes
• No

Have you ever used medicine (over the counter or prescription) on your skin?

• Yes
• No

What are your biggest skin concerns? (You can select more than 1)

• Fine lines
• Dull skin
• Hyperpigmentation or dark spots
• Open pores
• Deep-set wrinkles
• Skin firmness
• Melasma
• Acne

Do you wear sunscreen every day?

• Yes
• No

Have you experienced any outbreaks of facial eczema, psoriasis or perioral dermatitis in the last 6 months?

• Yes
• No

Do you have burning sensation when you apply water to your face

• Yes
• No

Do you apply sunscreen? If yes what type

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