Skin Consultation

Discover your ideal skincare routine with DERMA PH’s personalized consultations, crafted to provide tailored recommendations for your unique skin type and skin concern. DERMA PH offers high-quality solutions to help you achieve your best complexion. Start your DERMA PH journey with our quick and easy skincare quiz today!

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Name *

First

Last

Email Address *

Contact Number *

Age

How did you hear about us?

Allergies

3 a type

Please tick your skin type

Normal
Dry
Combination
Oily
Sensitive

Please tick your main 3 skin concerns:

Fine lines / Wrinkles
Pigmentation / Sun Damage
Redness
Blackheads (Comodones)
Whiteheads (Millia)
Acne / Acne Scarring
Rosacea
Enlarged Pores
Dark Circles
Textured Skin
Other
Eczema

If other, please specify

Please tick any medication you are currently using or have used:

Retinol
Glycolic Acid
Salicylic Acid
Topical Steroids
Benzoyl Peroxide (BPO)
Topical Antibiotics
Roaccutane
None

Do you follow a skin cleansing routine? If yes, enter details below

Do you use SPF Sunscreen

If there was something you could change or improve about your skin, what would it be ?

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