Pre Appointment Questionnaire – Arch Skincare – Personalised Skin Treatments in North Adelaide

Question 1 - Skin Photos

Please upload clear photos taken in natural light, without makeup for filters:

front view

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Left Side View

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Right Side View

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Close-up of any area you particularly want me to see

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Question 2 - Current Skincare Routine

Please upload a clear photo of all skincare products you are currently using. If anything is not visible or missing in the photo, please list it below

skin care products you are currently using. Include cleansers, serums, moisturisers, oils, exfoliants, retinol/retinoids, prescription creams and SPF.

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Please list any products that you use, that are missing from the photo.

How do you currently use your products - morning and evening

Question 3 - Supplements

If you are taking any supplements, please upload a photo of them or list the product names.

Are you currently taking any supplements?

Yes
No

Photo of any supplements you use.

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Please list any supplements that you use, that are missing from the photo.

Question 4 - Relevant Health Information

Please select anything relevant to your skin or product recommendations:

Diabetes
Eczema / dermatitis
Rosacea
PCOS or hormonal concerns
Pregnant or breastfeeding
Currently using or have previously used Roaccutane/isotretinoin
Prescription skin medication or creams
Known allergies
Other relevant medical condition

Please provide details of anything you have selected above, including relevant medications.

Question 5 - Previous Skin Treatments

Have you had any professional skin treatments recently or are you currently undergoing a treatment program? If yes, please provide detail.

Question 6 - Lifestyle

Is there anything about your lifestyle that you feel may be affecting your skin? For example stress, sleep, sun exposure, exercise or work environment.

Question 7 - Two-Day Food Diary

For the two days before your consultation, please record what you would normally eat and drink. Please do not change your usual diet for the diary. Quantities are not required. This gives me a general picture of factors such as protein, fibre and glucose/sugar intake that may be relevant to long-term skin health.

Breakfast - Day 1

Lunch - Day 1

Dinner - Day 1

Snacks - Day 1

Breakfast - Day 2

Lunch - Day 2

Dinner - Day 2

Snacks - Day 2

Question 8 - Anything else?

Is there anything else you would like me to know before your consultation?

Question 9 - Consent

I confirm that the information I have provided is accurate to the best of my knowledge and I consent to Arch Skincare using the information and images supplied for the purpose of my personalised skincare/product consultation.

I Confirm

WHAT CAN WE HELP YOU WITH?

WHAT CAN WE HELP YOU WITH?

before we meet