SKIN by Olga
Biologique Recherche skin care salon located in Donnybrook, Dublin 4. Professional Beauty Therapy, Facials, Waxing and Beauty Treatments
email@example.com 01 – 2608846
34 Donnybrook Road, Donnybrook, Dublin 4
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Please list any current medications are you taking
Do you use any of the following? Cleanser Exfoliator Toner Face mask SPF Serums Eye cream Moisturiser None of the above
Are you/have you recently been using products containing any of the below? Accutane Adapalene Lactic acid Glycolic acid Renova Vitamine A (ie. Retinol) Hydroxy acid Scrubs None of the above
Are you pregnant or currently trying to conceive?* Yes No
Do you smoke?* Yes No Occasionally
Do you suffer from breakouts? Yes No
Do you have a tendency towards redness? Yes No
Have you ever reacted to any of the following? Animals Cosmetics Food Fragrance Iodine Hydroxy acid None of the above
What are your main skin concerns?* Fine lines and wrinkles Discoloration (Brown Spots or Melasma) Rosacea, dilated capillaries or redness Acne scarring Enlarged pores Uneven texture Sun damage Loss of facial contours, lax or sagging skin Dark under-eye circles Other Other Detail
Have you ever had or are currently being treated for any of the following conditions? Cancer Diabetes Epilepsy Heart problems High/low blood pressure Hormone imbalance Systemic disease Thyroid Condition Varicose veins Hysterectomy Arthritis Hepatitis Anaphylaxis Lupus Keloid scarring Eczema Psoriasis Scleroderma Vitiligo None of the above
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