Skin Consultation - Freya Beauty & Skin Clinic Naas

Skin Consultation Form

Your Journey to Healthy Skin Starts Today!

We offer expert advice. Everyone’s skin condition is unique so please make sure you speak to a trained professional and booking a skin consultation in the shop or on our online form before using Juliette Armond products

Juliette Armand prides its Facials on being able to adapt to ‘your skin’s mood’. While understanding that we have different skin types, but also suffering from certain conditions.

For that reason talking to a professional about your skin, Can help you understand what our skin needs and finally teach you how to improve it and wear your best skin. These are thoroughly relaxing treatments that also deliver results.

Please fill out the form below to book your online consultation

Medical Details

We need this information to enable us to make treatment recommendations. We are committed to the safety and security of your data. Please view our privacy policy for more information.

Please tick the appropriate box below:

Are you currently taking any medication prescribed by a GP or any other practitioner?
YesNo

Are you currently pregnant, planning pregnancy or breastfeeding?
YesNo

Are you attending any GP or other practitioner for any other conditions?
YesNo

Do you have any allergies? E.g. Aspirin, allergies to ingredients in products?
YesNo

Skin Details

Please tick the appropriate box below:

What is your Skin type?
Dry (e.g. tight, dull & flakey)Oily (e.g. breakouts, blackheads & shiny)Combination (e.g. Dry cheeks, Oily T-zone)Normal (e.g. balanced and smooth)

Do you have a history of the following?
SmokingSunbedsNone of the above

How sensitive would your skin be?
Not SensitiveMildModerateVery Sensitive

Are you currently taking any medication containing vitamin A?
YesNo

Are you currently using any products that containing vitamin A?
YesNo

Photos

If you can take clear Photos of your skin in the following

Right Side Choose file No file chosen

Left Side Choose file No file chosen

Front Choose file No file chosen

Dietary Details

Please provide the appropriate information below:

A single measure of spirits; half a pint of average-strength lager; two-thirds of a 125ml glass of average-strength wine is = to 1 unit

Your Current Skincare Routine

Please give details in the appropriate boxes below:

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