• Video Consult Questionnaire

    Video Consult Questionnaire

  • (We know forms can be annoying and promise this will only take 3 minutes)

    The products we stock are medical grade so it's important we understand a bit about you before prescribing them. By submitting this form, you declare the information to be true, complete and correct. Please notify us if anything changes before the consult by calling 02 9386 1533.

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  • What is your preferred platform for the consult?*
  • Date of Birth*
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  • How often are you outdoors DURING THE WEEK?*
  • How often are you outdoors ON WEEKENDS?*
  • What are your current skin concerns? (Check all that apply)*

  • Do you have any active skin concerns? (Check all that apply)*

  • What other cosmetic procedures or treatments have you had? (Check all that apply)*

  • Should be Empty: