SkinMed Questionnaire

Free product tailored to your skin condition (worth at least $14.95) after receiving feedback on results of Skin Review - Please ask during telephone call back with our Advisors*

Please provide the following personal information so a professionally trained advisor may call you to discuss your skin issue, based upon the answers you have supplied.

*Delivery charges will apply and the free product can only be claimed once

Skin condition

FIRSTLY - WHAT CONDITION DO YOU HAVE?

1. Have you ever visited a doctor or specialist for treatment?

2. If YES, what treatment was suggested - please list products where applicable.

3. Have you ever changed your daily activities to avoid situations that make these skin conditions worse?

    Avoided the sun (UV)

    Avoided alcohol, spicy foods

    Limited outdoor activities

    Changed the way you dress

    Hidden your hands

    Used camouflage make-up

    Other

4. Do you feel that your skin condition can ever be completely cured?

5. Would you recommend any products that have cured/improved your skin condition?

Personal Details

Please provide the following personal information so a professionally trained advisor may call you to discuss your skin issue, based upon the answers you have supplied

*Name:


*Postcode:

*Telephone:


*E-mail:

Please enter a convenient day and time to call you on the above number.

How old are you?

Are you:

How did you find us?:

* Required fields