Virtual Skin Consultation Name Contact number Age Any medication? Please list Health problems?Allergies Lifestyle - stress levels, smoker, water intake, exercise regime, diet, alcohol intakeCurrent skincare routine and productsRecent chemical peels, laser or other resurfacing treatmentMain complaints with your skinDo you blush easily when nervous? Yes No Does you skin flush when you drink alcohol? Yes No Does you skin develop a shine during the day? Yes No Do you experience an itching or burning sensation with your skin? Yes No Skincare goalsHow much are you happy to pay to achieve your skincare goals? £100-£150 £150-£200 £200-£300 Thank you for filling out our virtual skincare consultation. We will review your form and come back to you with a recommended skincare regime. Please add your email address below so we can email you with your prescription when it becomes available. Please upload photos of your skin here. No make up or filters. In good lighting - ideally by a window. Full front and full sides of face.Max. file size: 64 MB.