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2 Consultation
3 Medical History
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What are your main skin priorities? (If there was anything you could improve about your skin, what would it be?)
Are there any particular areas of the face / body you would like to focus on today?
What is your treatment timeline expectation? (E.g., do you have any special events coming up?)
Your current skincare routine & products currently using:
Cosmetic Grade PeelMicrodermabrasion / AquaFacial / HydraFacialLaser / IPLAnti-Wrinkle InjectionsDermal FillersFacial Cosmetic SurgerySkin NeedlingFat FreezingBody Contouring
Details / When performed:
⬅ Previous
Please tick any of the following that apply to you:
CancerCancer therapyRadiation treatmentPhotosensitive medication or conditionsPregnancy / Trying / IVFSkin conditions (Eczema/Psoriasis)Lupus or Connective tissue disordersRoaccutane use (last 4 weeks)Recent sun exposure/solarium (last 2 weeks)Tanning agents including fake tanMelanotan IISpider veinsEpilepsyDiabetesVitiligoBlood born diseasesCold sores / Herpes SimplexActive fungal or bacterial infectionsTattoos or tattoo removalTopical ointments (Benzac/Epiduo/Akeif)
Other Medical Conditions (please explain):
Thyroid conditionPCOSHormone Replacement therapy
Regular Medications (antibiotics, antidepressants, etc.):
What medications, vitamins or supplements do you take on a regular basis?
Do you have any allergies? (Environmental or topical skin products):
Have you had any serious health problem / major surgery within the last 12 months?
Taking oral contraceptivesGoing through menopausePregnant / planning / lactatingUsing prescription skin medicationHistory of keloid scarring
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