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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?

Other areas of concern

Which of these pictures best depicts your acne?

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

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

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

Do you wear sunscreen every day?

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

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

Do you apply sunscreen? If yes what type

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