Your Online Skin Consultation

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Kindly complete the questions below to assist us in recommending the most suitable products for your skin.

Email *

Your Name and Surname *

Your Contact Number *

Do any of the following statements apply to you? *

I currently have severe eczema

I currently have active dermatitis (allergic or itchy skin)

I currently have open cuts/sores/infected wounds

I am pregnant/breastfeeding/planning pregnancy

I am on oral Vitamin A medication (Isotretinoin)

None of the above apply to me

Required

Do you have any allergies? *

Yes

Please describe your allergies if you answered yes to the previous question? *

Your Gender? *

Male

Female

Your Age? *

Under 20 Years

21 - 25 Years

26 - 30 Years

31 - 35 Years

36 - 40 Years

41 - 45 Years

46 - 50 Years

51 - 55 Years

60+ Years

Choose your skin type? *

Oily

Dry

Combination

Acne

Sensitive

Choose your main concern? *

Fine lines and wrinkles

Textured

Sensitive

Pigmentation

None of the above

Choose your main concern? *

Fine lines and wrinkles

Textured

Sensitive

Pigmentation

None of the above

Thank you for taking the time to complete our skin assessment. You will receive an introduction mail with our recommendations and the access code to purchase your products online. Please confirm the following before you submit. *

I confirm that I filled out this assessment personally

I confirm that all information is correct

Buying products from Acknowledge Health & Beauty are hight in active ingredients to give you the best results. I accept that if I purchase Active Ingredient Products outside of what Acknowledge Health & Beauty - The Skin Consultant Recommends, I do so at own risk

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