Online Consultation Fill in our consultation form to get the best from our skincare products. Step 1 of 3 33% Personal DetailsName* First Last Phone Email Date of Birth* DD slash MM slash YYYY General InformationHow much is a consultation? There is a €30 deposit taken at booking which is then redeemable if you spend €80 or more off products that are purchased on the day of your consultation. If you decide to not purchase products then the consultation cost €30 is not redeemable.How can I get a consultation? Fill out the form below with as much detail as possible and pick a day and time that suits you for our team to give you a call. Must be between 9am and 7pm. We will call you at the chosen time. You can also choose either a zoom call or a phone call, which ever you prefer.What happens after your consultation? As part of your consultation process you will receive 2 follow up calls from our skin team. We are here to support you through your skin journey. We do not charge for this follow up. We arrange to call you 4-6 weeks after your initial consultation, to check that all is going well and that you understand how to use the products correctly and see if any tweaks to your routine are necessary. After this we schedule one more call 4-6 weeks later which is free of charge also here we make sure that you are reaching optimum skin health. Follow up calls after this time will be charged at €25 which is fully redeemable against any products purchased that day over the phone. Once you continue to be a Touch and Glow client we are here to support and guide you throughout your Skin health journey.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Medical Consent Please choose the appropriate options below.Are you currently taking any medication prescribed by a GP or any other practitioner? Yes No If yes please please provide further information Are you currently taking any medication containing vitamin A? Yes No If yes please please provide further information List any vitamins / supplements that you take regularly.Are you attending any GP or other practitioner for any other conditions? Yes No If yes please please provide further information Do you have any allergies? E.g. Aspirin, allergies to ingredients in products? Yes No If yes please please provide further information Skin QuestionnaireWhat is your skin type? Dry (Eg Tight, Dull & Flakey) Oily (Eg Breakouts, Blackheads & Shiney) Combination (Eg Dry Cheeks, Oily T-Zone) Normal (Eg Balanced & Smooth) What are your main skin concerns Fine Lines Wrinkles Enlarge Pores Pigmentation Acne Redness Rosacea Uneven Skin Tone Do you have a history of... Smoking Sunbeds How senstive would your skin be? Not Sensitive Mild Moderate Very Sensitive Do You Apply SPF daily? Yes No Are your prone to or currently have the following? Eczema Psoriasis Rosacea Herpes Simplex Do you get any of the following? Comedones/Blackheads Pustules/White Heads Cystic Acne Occasional Spots Hormonal Breakouts Never Breakout Are you happy with your current skincare & seeing results? Yes No What are you happy with about your skin?What are you happy with about your skin?Rate your level of stress 1-5, 5 being the highest. 1 2 3 4 5 What is your current skincare routine? Please complete each below.Cleanse Toner Serum Moisturiser Mask Eye Cream Do you do this AM and PM and is there anything additional you use on the skin that’s not listed above?Do you have a nut allergy? Yes No What are your skincare goals/what would you like to achieveAre you attending any GP or other practitioner for any other conditions? Yes No For your consultation what would you prefer? Zoom / WhatsApp Call Option Email Option Product Name* Price:
