Online consultation for Lamelle

Name

Surname

Gender
MaleFemale

Date of birth

Contact Number

Do you tend to react easily to skincare products?
YesNo

Do you suffer from Psoriasis,Eczema,Rosacea or Dermatitis?
YesNo

From a scale of 1 (very oily) – 10 (Normal) please rate your skin
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From a scale of 1(very dry) – 10(Normal) please rate your skin your skin
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