Skin Analysis 1Step One2Step Two3Step Three4Step Four YOUR NAME YOUR AGE Under 16 16-24 25-40 41-60 61+ YOUR EMAIL ADDRESS YOUR PHONE NUMBER PLEASE TICK THE SKIN CONCERNS THAT APPLY TO YOU THAT YOU WOULD LIKE TO IMPROVE: ACNE CONGESTION Dull SKIN LINES AND WRINKLES PIGMENTATION ROSACEA SCARRING OTHER BLACKHEADS DEHYDRATED ECZEMA OPEN PORES REDNESS SAGGING UNEVEN TEXTURE IF OTHER PLEASE SPECIFY:SKIN SENSITIVITY NORMAL SENSITIVE VERY SENSITIVE IF YOUR SKIN IS SENSITIVE / VERY SENSITIVE PLEASE GIVE DETAILS.PLEASE DESCRIBE SKIN ON YOUR T ZONE AREA (FOREHEAD, NOSE AND CHIN) DRY NORMAL OILY SENSITIVE OTHER IF OTHER PLEASE SPECIFY:PLEASE DESCRIBE SKIN ON YOUR CHEEK AREA DRY NORMAL OILY SENSITIVE OTHER IF OTHER PLEASE SPECIFY:PLEASE DESCRIBE SKIN ON YOUR EYE AREA DARK CIRCLES LINES / WRINKLES PUFFINESS SENSITIVE OTHER IF OTHER PLEASE SPECIFY:DO YOU CURRENTLY USE ENVIRON? Yes No PLEASE DESCRIBE YOUR CURRENT SKINCARE ROUTINE?WHAT SKINCARE PRODUCTS ARE YOU CURRENTLY USING? DO YOU SUFFER FROM ANY OF THESE SKIN CONDITIONS? ECZEMA PSORIASIS ROSACEA BREAKOUTS NONE OF THE ABOVE WHERE DOES YOUR PSORIASIS EFFECT YOU? FACE BODY BOTH FACE AND BODY WHERE DOES YOUR ECZEMA EFFECT YOU? FACE BODY BOTH FACE AND BODY HAS YOUR ROSACEA BEEN MEDICALLY DIAGNOSED? YES NO ARE YOU TAKING ANY PRESCRIPTIVE MEDICATION INCLUDING TOPICAL CREAMS? YES NO IF YES PLEASE STATE THE MEDICATION BELOW:HAVE YOU USED ROACCUTANE BEFORE? YES NO IF YES WHEN DID YOU FINISH TAKING IT?ARE YOU PREGNANT, TRYING TO BECOME PREGNANT OR BREASTFEEDING? I AM CURRENTLY PREGNANT I AM CURRENTLY BREASTFEEDING I AM TRYING TO BECOME PREGNANT DO YOU HAVE ANY ALLERGIES? (e.g ASPIRIN) YES NO IF YES PLEASE SPECIFY:ARE YOU CURRENTLY HAVING ANY FACIAL OR SKIN TREATMENTS? YES NO IF YES PLEASE DESCRIBE YOUR TREATMENT: HOW WOULD YOU DESCRIBE YOUR DIET?HOW MUCH WATER DO YOU DRINK PER DAY? WHAT MAKEUP BRANDS ARE YOU CURRENTLY USING?WHAT CHANGES WOULD YOU LIKE TO SEE IN YOUR SKIN?IS THERE ANY ADDITIONAL INFORMATION YOU WOULD LIKE TO PROVIDE?TO HELP COMPLETE YOUR CONSULTATION PLEASE UPLOAD A PHOTO / PHOTOS OF YOUR SKIN (YOU CAN SKIP THIS SECTION IF YOU WISH) Drop files here or Select files Max. file size: 32 MB, Max. files: 10. PLEASE TICK TO SAY YOU HAVE READ & AGREE TO OUR TERMS & CONDITIONS:* I AGREEI agree to my information being store used by the Sanctuary to provide me with a personalised skin analysis. Your details are safe with us we will never share any of your personal details with any 3rd parties. For full terms and conditions of using our website click here.CAPTCHA
