Are you currently taking any medication prescribed by a GP or any other practitioner?*
Are you currently taking any medication containing vitamin A?*
Do you have any allergies? E.g. Aspirin, allergies to ingredients in products?*
Are you attending any GP or other practitioner for any other conditions?*
Skin Details - Please tick the appropriate box below:
Do you have any of these skin conditions?*
What are your main skin concerns?*
Do you have a history of the following?*
How sensitive would you say your skin is?*
Are you prone to or currently have the following?*
Do you get any of the following?*
What is your current skincare routine?
Please upload the following images of cleansed skin areas for one of our skin specialists to analyze your skin and your skincare recommendations.
I agree I have given the correct information above.*
I give my permission for La Bella Med Spa to post any videos or photos of services performed on me and any relating descriptive information obtained on me to its social media sites including its website, Instagram and Facebook for educational purposes of the other clients.
By using this form you agree with the storage and handling of your data by this website*
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