Online Prescription

Do you or have, or have you had any health problems you think may have contraindications to any treatment? E.g cancer, asthma, coldsores*
- Yes
- No
Are you on any medication we should know about?*
- Yes
- No
Are you allergic to aspirin?*
- Yes
- No
Do you smoke?*
- Yes
- No

Photos
Photo - Face on*
Photo - Side on
Photo - Side on
Privacy Statement
The skin care history and health information you have provided is used to help our therapists recommend skin care treatments and home care products that are suitable for your skin and condition. It is accessible to authorised staff for that purpose only and my be accessed by you at any time.
I confirm to the best of my knowledge that these answers are correct and that I have not withheld any information that may be relevant to my treatment.*
- Yes. I confirm this information is correct.
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