1. Name:

2. Contact Number:

3. Medical History :

4. Age:

5. Do you have any allergies:

6. Your current skin regime:

( what brand of products are you currently using and which products of that brand your currently on, example Face Wash, Exfoliator ect.)

7. Do you use sunscreen and for how many years?

8. Do you use makeup? 

9. What are your Skin concerns? 

10. How long has the hyper-pigmentation occurred?  Which area of the face?

11. Do you prefer a matt/light weight or hydrating cream?

12. If you can send me a picture with no makeup. 

email info@nbskinscience.com

or wats app 0832071157 ( Monday- Friday, 9am -5pm )