Please take some time in completing your consultation form and be as honest as you wish, as this will aid us in giving you the best service possible. Our therapists are highly trained, and are here to guide you to the products which will help you to be a healthier and happier you.

Please be aware that the information you provide will be used solely for the purposes of providing you with a skincare routine and will be in NO WAY shared with any 3rd parties.

When you have filled out the form please press submit. This will load your results into an email using your e-mail package. Simply send this e-mail to us and we will endevour to contact you within 48 hours.

Name:
Address:
Mobile Number:
Date of Birth:
Skin Types & Concerns:	Normal Dry Combination Oily Acne Sensitive Extra Sensitive Sun Damage Lines/Wrinkles High Colour Pigmentation Dark Circles/Puffiness If others, please provide...
LIFESTYLE
What is your quality of sleep:	Deep Light Disturbed
How often do you exersice?	Never Daily Weekly
Do you smoke?:	No 1-20 per day 20+ per day
DIET
How would you describe your diet?	Balanced Moderate On-the-run Poor
How many units do you drink per day?	Water Fresh Juice Alcohol Coffee Tea
Are you a Vegeterian?	No Yes
What is your current skincare routine?	Please provide...
Body Concerns?	Dry Skin Cellulite Overweight Poor Circulation Aches/Pains Varicose Veins If others, please provide...
What is your current bodycare routine?	Please provide...
Do you suffer medically from any of the following?	Allergies Eczema Arthritis Hyperthyroid Heart condition IBS Epilepsy Psoriasis Claustrophobia Back problems Asthma Cancer Rheumatism Iodine (seaweed allergy) High blood pressure Low blood pressure
Are you going through any of the following?	Depression Menopause Headaches/Migrames PMT Pregnancy Breast Feeding   If others, please provide...
MEDICAL HISTORY (if yes please detail)
Are you on any medication or under any medical supervision?	Yes No
Have you had any recent surgery, accidents or injuries?	Yes No
	If so, please provide...