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Environ Online Skin Consultation

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Skin Care
Emi's Skin Clinic
Online Skin Consultation

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Surprise Gift with every order

Online Skin Consultation

Our highly trained team will guide you on your journey to healthy, glowing, beautiful skin.

We charge a €25 Euro deposit to process Skin Consultations, it is fully redeemable against instore and online purchases.

Pay €25 Deposit

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Emi skin clinic

Full Name*

Address

Year of birth*

Phone*

Email*

Have you had a consultation with us before? No Yes

Do you have a shopper ID?

What's your main skin concern? Psoriasis
Scarring
Pigmentation
Excessive Dry / Dehydrated
Sun Damage
Frown lines
Thin Skin
Reactive/sensitive
Acne
Rosacea
Eczema
Oily

Are you prone to any of the following? Psoriasis
Keloid Scarring
Eczema/Dermatitis
Rosacea
Herpes

If you have any above conditons, what area and how long present?

Have you recently been treated with any of the following? Topical Corticosteroids
Oral Corticosteroids
Topical Vitamin A
Benzal Peroxide
Azelaic Acid
Saliclic Acid
Alpha Hydroxyl Acids
Oral Antibiotics
Topical Antibiotics
Other Acne Treatment

Have you taken Roaccutane in the last 6 - 12 months?* No Yes

Are you allergic to Asprin?* No Yes

Have you been treated with any of the following?

HRT (hormone replacement therapy)* No Yes

Contraceptive Pill* No Yes

Are you, or do you have any of the following?

Pregnant* No Yes

Breast feeding* No Yes

Smoke* No Yes

Sun beds* No Yes

Do you take any vitamin supplement?

What skin care products do you currently use?

What make up do you currently use?

Are you currently using any Environ products?* No Yes

If so please specify Environ products you are using

What Environ products are you interested in using?*

Additional Information?

Your skin condition image (jpg, jpeg, png files only)

I confirm the information I have given is correct and I am over 18 years of age.*

Thank you for joining us on your journey to healthy, glowing, beautiful skin!

We will review your form and send your consultation by email

Depending on volume it can take 1-2 working days for response.

We charge a €25 Euro deposit to process Skin Consultations, it is fully redeemable against instore and online purchases.

Pay €25 Deposit Now

Emi skin clinic 200

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Hours
Mon-Fri 9.30-6pm
Sat 9.30-1.30pm
Sun Closed

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Contact
Unit 3 Aldi Complex
Old Lucan road Dublin 20
01 - 6208500
Email

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