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Personal information:

Name *

Date of birth *

Phone *

Surname *

Email *

A convenient way to get in touch *

Information about skin:

Skin type

DryOilyCombinationNormal

Skin problems

Currently used cosmetic products

Additional information about the skin:

Skin sensitivity

Common problems

History of cosmetics use:

Brands and products

Skin reaction

Problem description:

Brief description of the problem

How long ago did the problems occur

Personal photo:

Front and side photos of the face, well lit and clear

Maximum size: 25 Mb

JPG, PNG

Privacy and consent to the processing of personal data:

Confidence in the confidentiality of the data providedConsent to data processing and terms of use of information

Adding these items will help the aesthetician to better understand the patient's skin characteristics and needs, allowing them to offer more individualised recommendations and treatments.