KYC Form - Overseas Clients
Let us know you a little better
Увійдіть в обліковий запис Google, щоб зберегти надані відповіді. Докладніше
Електронна адреса *
Please provide us your full name *
What is your date birth? *
ДД
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ММ
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РРРР
Where are you currently residing? *
What time zone are you in? (E.g. GMT +8) *
What is your nationality? *
What is your occupation? *
How do you know about Skin Health Centre? *
Обов’язково
If you have selected Facebook support groups or TSW Instagram community, please specify which support group or Instagram account. (You may skip if you did not check either of these two options)
What skin condition do you have? *
How long have you been experiencing this skin condition? *
Are you currently on any treatment or medication for your skin condition? *
If yes, what treatment or medication are you on? (skip this question if you are not on any treatment or medication)

Please write a brief history, in chronological order of your skin condition. Please use the following format:

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Зображення без підпису

Have you started Topical Steroid Withdrawal?

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Have you started Moisturiser Withdrawal?

 *

Please check the boxes if you have had or are currently experiencing any of the following:

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Обов’язково
If you have any drug allergies, please specify which what drugs allergies do you have?

Do you:

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Обов’язково

Please provide us with your contact number that is linked to your WhatsApp:

 *

Please provide us with your email address:

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Have you sent us photos of your current condition and your worst flare?

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If no, please send us photos of your current condition and your worst flare (of all affected areas) to the Skin Health Centre hotline via WhatsApp https://wa.me/+6588944322

Thank you for your response, we look forward to journeying with you on your skin recovery journey!

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