TGA online consultation

Date*

Name*

First Last

Email

Are you currently on medication?*

What medication are you taking?

We must know as medication can impact your skin.

What is your main skin concern you'd like to achieve?

Check whats relatable to your skin:*

What products are you currently using - AM & PM?*

Do you have skin treatments?*

Have you had skin treatments in the past and if so what are they?*

Please upload a photo of your skin or your skin concerns

Is there any additional information we should know?