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No6 Clinic Consultation Form

Please complete the following form to start your skincare consultation with our expert skin specialists.

Once completed and you have been assessed for suitability by our expert specialists, you will receive product recommendations in an email. The hidden Dermaquest and Environ products will then be unlocked and visible for you to browse and buy in our exclusive online store.

Please note, online consultations are approved Mon-Fri 9-5pm. If completed after 3pm then you will be assessed on the next working day. Any questions, please email [email protected]

* = required information

    About You

    Title

    First Name *

    Last Name *

    Date of Birth *

    Address

    Line 1 *

    Line 2

    Town *

    County *

    Postcode *

    Contact Information

    Email Address *

    Confirm Email Address *

    Telephone *

    Preferred contact method
    EmailPhone

    Medical History

    We need this information in order to assess your Environ and Dermaquest product suitability. This sensitive information is encrypted in our database, and will be deleted 48 hours after we have contacted you. It is not used or kept for any other purpose.

    Do you have any Medical Conditions? *
    YesNo

    If yes, please provide details

    Do have any allergies? *
    YesNo

    If yes, please provide details

    Are you currently pregnant or breastfeeding? *
    YesNo

    Your Skin

    Would you burn within 20 minutes in the sun without SPF? *
    YesNo

    What is your skin type? *
    Very FairFairCream/WhiteOliveDark BrownBlack

    How do you find your skin? *
    OilyCombinationSensitiveDryNormal

    Please state your skin concerns (if any)

    Other Information

    Please state any products you are currently using *

    What are your expectations from using products? *

    Products interested in purchasing

    * I agree : I confirm to the best of my knowledge that the answers given are correct and I have not withheld any information for the use of Environ products. I understand that results cannot be guaranteed. I will inform skinaddict.co.uk if any of this information changes.

    * = required information

    Once your entry and has been approved, you will be able to browse and buy Environ products from this website. These categories are exclusively available to our approved clients.

     

    Free skincare consultation with our No.6 Clinic® expert skin specialists!

    Is my personal information safe?
    We take the security of your personal information very seriously :
    (1) we use a secure SSL connection to our server
    (2) your medical information is encrypted in our database
    (3) your data is reviewed using a secure SSL connection
    (4) once you have received our recommendations your data is deleted from our server after 48 hours, and only a paper copy kept on record.

    What happens next?
    If you haven’t done so already, create a customer account at skinaddict.co.uk

    We will review your information and send you a personal recommendation, and give you access to the Dermaquest and Environ product areas on skinaddict.co.uk    .

     

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