Book a Consultation | Malora Beauty Skincare Consultation

Full Name: * E-mail: * Phone Number: * Date of Birth: * Skin Quality: * Skin Sensitivity: * Do you have Allergies / Intolerance (e.g Aspirin): * No Yes Have you had Facial Surgical Procedures? * No Yes Have you had Laser Hair Removal? * No Yes Have you had Laser Treatments? (e.g IPL) * No Yes

Have you had any of the following? * Botox/ Fillers(last 2 weeks) Microdermabrasion (last 2 weeks) Waxing (inculding facial waxing, in the last two weeks) Chemical Peel (last 2 weeks) Moles or Sun-Spots removed (in the last 12 months) None of the Above

Have you had any other Skincare Treatments? * No Yes Have you had any facials in the last 3 months? * No Yes

Are you pregnant, trying or breast feeding? * No Yes Are you diabetic? * No Yes Do you suffer from Porphyria? * No Yes Do you have a pacemaker or cardiac irregularities? * No Yes Do you have facial metal implants and/or excess fillings? * No Yes Are you a smoker? * No Yes Do you suffer from any skin conditions? (e.g eczema, psoriasis) * No Yes Do you have or have you ever suffered from Rosacea? * No Yes Have you had any recent illnesses? * No Yes

Are you taking any of the Following? * Topical or Oral Cortisone / Prescribed skin treatment Topical or Oral Antibiotics HRT Contraceptive Pill Roaccutane or any other prescribed oral antibiotics for the skin None of the Above

How would you describe your diet, in as much detail as possible? * How much water do you drink per day? * How many units of alcohol do you usually consume per week? * What skin care products are you currently using? (Please include brands) * AM Routine? * PM Routine? * What Makeup brands are you currently using? * What changes would you like to see in your skin? * Please upload three photos of your skin with no makeup.
One front-facing and one of each side of your face

Left side Images
(max file size allowed 2mb.)

Centre Images
(max file size allowed 2mb.)

Right side Images
(max file size allowed 2mb.)

Your Order Summary:

€10.00

ONLINE CONSULTATION

Consultation fee is fully redeemable off products purchased within 7 days.

ORDER TOTAL:

€10.00

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