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Pure Obagi

Cómo contactar con nuestros socios de Skinstation

Para que los médicos especializados de Skinstation puedan ofrecerte consejo sobre la amplia gama de productos Obagi, será necesario que completes el formulario de abajo. Una vez completado, se pondrán en contacto contigo para organizar una consulta telefónica con un miembro de su equipo médico. Ellos se asegurarán de que obtengas los productos adecuados y de que consigas los mejores resultados clínicos posibles para tu tipo de piel. Recuerda que todas las consultas se realizan en inglés.

Name *

Nombre

Apellidos

Email *

Contact number *

Date of Birth *

DD/MM/YY

Please confirm that you are over 12 years of age by ticking this box *

I confirm

Please choose your skin type from the list below *

Pale white skin, blue/hazel eyes, blond/red hair (Always burns, does not tan)
Fair skin, blue eyes (Burns easily, sometimes tans)
Darker white/medium skin (Sometimes burns, always tans)
Light brown skin (Burns minimally, tans easily)
Brown skin (Rarely burns, always tans)
Dark brown or black skin (Never burns, always tans dark)

Do you currently have or have you ever suffered from any of the following medical conditions? *

Diabetes
High blood pressure
Ocular pressure problems
Hormone imbalance
Cold sores
Skin disease/skin lesions
Pigmentation abnormalities
Keloid scarring
Any active infection
Any allergies

Any other medical conditions?

Are you currently taking any medication? If so, what is the medication and what are you taking it for? *

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

I confirm

Please confirm that these items are for your own personal use *

I confirm

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

I confirm

Do you have any other health issues that we should be aware of? *

No
yes

If yes, please give details of other health issues we should be aware of:

Please give us a small description of your skin issues and what you are looking to achieve: *

Would you like to upload a picture of your skin to help us better assess you? and if you could give us a small description of what skin issues you would like to address.

Haz clic o arrastra un archivo a esta área para subirlo.

Contacto

Pure Obagi
Ground Floor,
Unit C16, The Exchange, Calmount Business Park, Ballymount,
Dublin 12,
D12 RF43,
Ireland

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