My Skin Journey – RÖ Skin & Wellness

Start by choosing your skin concern *

What is your name? *

First

Last

We need to put your legal name on the prescription. Rest assured, your data is safe.

What's your birthday? *

Your skin changes with age so we want to make sure we're recommending the right skincare for you.

What's your sex at birth? *

Male
Female

We need this because your hormones are closely connected to your skin. We respect that your identifying gender might be different.

What are your biggest skin concerns? *

What type of skin do you have? *

Normal
Dry
Oily
Combination

How sensitive is your skin? *

Not sensitive - I rarely react to any skincare products
Sensitive - my skin sometimes reacts to skincare products
Very sensitive- my skin usually reacts to skincare products

Do you have any medical conditions? *

Yes
No

Please provide details on your medical condition.

Do you take any medication, including prescription medication, antibiotics, over the counter medication or recreational drugs? *

Yes
No

Please provide details on your medication.

Have you ever had any bad reactions to any tablets or creams in the past, either prescribed or things you bought over the counter without a prescription? *

Yes
No

Please provide details.

Do you have any allergies? *

Yes
No

Please provide details of your allergies.

Are you pregnant, planning on becoming pregnant or breastfeeding at the moment? *

Yes
No

If you become pregnant unexpectedly while on anti-ageing treatment, please consult with the RÖ SKIN Team immediately.

I understand

Do you wear sunscreen everyday? *

Yes
No

The majority of anti-ageing treatments can cause the skin to become more sensitive to sunlight. We recommend you use an SPF of 15 or higher while using anti-ageing treatments and avoid sun beds and direct exposure in strong sunlight.

I understand

What skin care are you currently using?

Do you take any vitamins or supplements for your skin? *

Yes
No

Please provide details.

skin provide What's

What kind of foundation or powder do you wear?

Where do you work?

Inside
Outdoors
City worker

What kind of sun exposure do you get?

On average how well do you sleep?

Less than 4 hours
5 hours
6-7 hours
8 hours or more

Describe your stress levels?

What is included in your diet?

How would you describe your diet in general?

You will contact us if you experience any side effects of your skincare, if you start a new medication or if your medical conditions change during treatment. *

I agree

The treatment is solely for your own use. RÖ Skin recommends a full consultation with one of our team Virtually or In clinic for the best results.. we recommend follow up consultations 2-4 times a year as your skin changes *

I agree

Please contact the RÖ Team if you have any questions. You have answered all the previous questions accurately and truthfully. You understand our skin team take your answers in good faith for your best results. *

I agree

Would you like to be contacted By the RÖ Team about your skincare? *

Yes
No

How would you prefer to be contacted?

Email
Telephone

What is your best contact number?

What is your email address?

Please upload some photos of your skin concern for our team to review

Drag & Drop Files, Choose Files to Upload