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Home
Treatments
Facials
Medilux LED Light Therapy
Skin Needling
Lumifusion
Lumixa
Melanopro
Nail Treatments
Waxing
Lash & Brow Services
Spray Tanning
Gift Vouchers
Contact Us
Home
Treatments
Facials
Medilux LED Light Therapy
Skin Needling
Lumifusion
Lumixa
Melanopro
Nail Treatments
Waxing
Lash & Brow Services
Spray Tanning
Gift Vouchers
Contact Us
Questionnaire
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Name
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Last
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IMPORTANT - Please let us know if any of these apply to you?
Use of Prescription Vitamin A eg: Retrieve, Tretinion, Adapalene etc
Are you on antibiotics for a bacterial or viral infection
Any skin allergies or if skin is irritated or impaired at the moment
Cold Sores (must use antiviral 3 days pre and post peel)
Pregnant or Breast Feeding
Active Acne Breakouts
Use of Hydroquinone in the last 12 weeks
Hypersensitivity to Light or Light Sensitive Medication
Eczema, Psoriasis, Rosacea on Face
Diabetes
Cancer, Lupus, Chemotherapy, Radiation etc.
Thyroid Issues or use of Thyroid Medication
Tendency to develop Keloid Scarring
Hair Removal in the last weeks waxing, laser
Any Pigmented Lesions which are raised, rough, flaky or unusual must be checked by a GP prior
Use Roaccutane within the last 12 months
What sort of skin do you think you have?
Dry
Normal
Combination
Oily
Please tick which best describes your skin IF you went out in the sun for long period?
I burn / peel and freckle and do no tan
I usually burn / peel, usually freckle and rarely tan
I may burn, might freckle and sometime tan
I wouldn't really burn, don't freckle and often tans
I almost never burn, rarely freckle and always tan
I never burn, never freckle and always tan
Do you use Cleanser & Moisturiser?
Yes
No
Others
If you use Facial Serums, Please tick which ones? (optional)
Vitamin A - Retinol (beauty products only not prescription from chemist)
Vitamin C - Ascorbic Serums
Hyaluronic Acid - Hydrating Serums
Vitamin B - Niacinamide
Others
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