Consultation Form

Please confirm that you are over 18 years of age by ticking this box

Please confirm that you are not pregnant, brestfeeding or planning on getting pregnant

Please confirm that these items are for your own personal use

I choose to waive the option of a face-to-face consultaion and confirm that all of the information provided is true and correct

I give my consent that the prescribing Clinician can prescribe to me

I am aware that by not using the full Nu Derm System with Tretinoin (retina-a) I may not achieve maximum results and it will also take longer to achieve results.

I am aware that I must not wax whilst using the Obagi products, and need to seek advice prior to undertaking peels and facial laser treatments

I confirm that I am requesting registration with Aesthetic Skin Clinic

If you are beginning on a new prescription medicine, we would always suggest to perform a test patch 24 hours before commencing treatment to make sure there are no reactions.

A request for any product which is a prescription medication requires the Prescribing Clinician to establish enough information to ensure safe and appropriate prescribing for medical need.

To ensure safe and effective treatment, a clear photo of your skin concern is required. Without this, we are unable to process your prescription. Thank you for helping us with this important clinical information.