SKIN CONSULTATION

Skin Consultation

• Call or FaceTime

• Skin prescription customised to your skin and concerns

Please fill in the form below for your Free Skin Consultation and The Beauty Room By Peta will be in-touch.

Name

Date

Address

Email

Phone

Known Allergies

Medication

What are your skin concerns?

Acne - for how long?

Clogged Pores

Comedones

Cystic Acne

Milia

Papules

Pustules

Dialted Pores

Dull Skin

Oily Skin

Dehydration

Dryness

Flakiness

Pigmentation

Sun Damage

Thin / Sensitive Skin

Broken Capillaries

Rosacea

Expression Lines

Fine Lines

Loss of Elasticity

Scarring

Other Concerns

Notes, remarks and other recommended treatments

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