Exit

TMC SKIN SHOP

Once you have submitted the below consultation form, please book your free video consultation with one of our skincare specialists via the link at the end of the form. *Please note we will not be able to go ahead with the video consultation if you have not completed a survey.

Question Title

* 1. First Name:

Question Title

* 2. Surname:

Question Title

* 3. DATE OF BIRTH

Question Title

* 4. EMAIL ADDRESS

Question Title

* 5. CONTACT NUMBER

Question Title

* 6. Full Address (This will also be used as your delivery address for any skin products we will send out to you):

Question Title

* 7. Which describes you best?

Question Title

* 8. Have you used any medical grade products before? If yes, Which ones?

Question Title

* 9. Which best describes your skin condition?

Question Title

* 10. What is your Skin Type? 

Question Title

* 11. Do you have Sensitive Skin 

Question Title

* 12. Do you have any Allergies? If Yes, please state them below. If no, please type 'none':

Question Title

* 13. In your own words, what do you dislike about your skin? 

Question Title

* 14. What are your main concerns? 

Question Title

* 15. Would you consider in clinic treatments if we think its necessary alongside your at home skin care? To get the best outcome we may need to recommend some in clinic treatments as well as your new 'At Home' skin routine 

Question Title

* 16. Have you used Roaccutane for Accutane in the last 6 months? 

Question Title

* 17. Are you allergic or sensitive to any of the following: 

Question Title

* 18. Are you currently undergoing any treatment for autoimmune disease or anti- cancer treatment? such as radiation or chemotherapy 

Question Title

* 19. Have you had any of the following within the last 2 weeks ( Facials including Chemical peels, Facial Lasers? Such as Laser Hair removal or Skin Resurfacing Laser, Dermal fillers, Skin Boosters or Botulinum Toxin, Any surgical treatments on the face, or any other skin care treatments not stated above. If yes, please state below which ones we may need to know about? 

Question Title

* 20. Are you pregnant, breastfeeding or currently undergoing/ planning to undergo IVF within the next 6 months?

Question Title

* 21. What is your Skin Goal?

Question Title

* 22. Please upload a clear photo of your skin in normal daylight, no filters. Your photo must be of your full face, front view. A full face photo is necessary for medical purposes and will not be shared with anyone other that The Medical Clinic for review. 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 23. What is a reasonable budget to achieve this goal? 

Question Title

* 24. Which products are you interested in purchasing? (If you don’t know just say- I don’t know)

Thank you for taking the time to complete our online consultation form. Our Skin experts will now review your form. A video consultation is required before purchasing any medical grade skincare, you can book your free consultation here.

Your personalised and bespoke skin care routine & prescription will then be sent to you via the provided email. If you were unable to load your photos in this form, or if you have any questions please email them to skin@themedicalclinic.co.uk

We are excited for your new skin journey!
TMC Skin Team x

T