Skin Consultation Questionnaire

Please complete the form below before your consultation with the Skin1 Pharmacy Skin Clinic team.

This questionnaire helps us better understand your skin concerns, current skincare routine, medical history and treatment goals so we can provide more personalised skincare advice and treatment recommendations.

Whether your concerns include acne, sensitivity, rosacea, pigmentation, dehydration, signs of ageing or general skin health, the information you provide helps our team prepare for your consultation.

Before You Begin

• Please answer all questions as accurately as possible
• Include details of any skincare products or medications you are currently using
• Upload photographs if requested to help our therapists assess your skin concerns
• The form typically takes approximately 3–5 minutes to complete

All information submitted is treated confidentially and used solely for consultation and treatment planning purposes.

Disclaimer: Recommendations are based on the information provided and do not replace medical advice or diagnosis from a doctor or dermatologist.