top of page
Zoom Skincare Consultation
with Joanna Fleming
What is your full name?
What's your email address?
What is your age?
How would you describe your skin type? (Select all that apply)
*
Required
Normal
Combination
Dry
Oily
What are your primary skin concerns? (Select all that apply)
*
Required
Acne
Pigmentation (ie. sun damage)
Redness
Dryness
Oiliness
Dullness
Fine Lines
Enlarged Pores
Blackheads
Post-inflammatory Hyperpigmentation
Other (detail below)
How would you describe your Fitzpatrick skin type (natural colour of your skin/tolerance to sun exposure)?
*
Required
Type 1: Very fair skin, red/blonde hair, always burns, freckles
Type 2: Fair skin, burns easily, tans minimally
Type 3: Medium/olive skin, sometimes burns, usually tans
Type 4: Medium to deep skin, rarely burns, tans easily
Type 5: Deep skin tone, very rarely burns, always tans easily
Type 6: Very deep skin tone, never burns, deeply pigmented
Tell me what you're currently using (brand & product name) AM and PM for skincare, and the order in which you're applying the products:
What’s not working in your routine/why are you wanting to overhaul your current routine?
Are there any products you really like that have had a positive impact on your skin? Tell me about them:
Have you ever seen a dermal therapist or dermatologist for any of your concerns? Have you had any professional treatments in the last 12 months? Please detail:
Have you ever had a reaction to a skincare product? (ie redness, itching, sensitivity)
Are you currently taking any medications or supplements? Please detail below:
Have you been on Roaccutane/isotretinoin in the last 6 months?
*
Required
Yes
No
Are you pregnant or breastfeeding?
*
Required
No
I'm Pregnant
I'm Breastfeeding
Are there any lifestyle factors that may be impacting your skin? (eg smoking/vaping, food intolerances, stress) Please detail:
How would you describe your budget?
*
Required
Happy to splurge
Not prepared to go too overboard but hit me with your recommendations
Keep it simple, the purse strings are tight
Please share a clear, closeup 5-10 second video of your bare skin with no makeup in natural light. Please take this video facing a window, turning your head from the centre, to the left then right. Please do not submit imagery taken at night with overhead lighting.
Upload File
Upload supported file (Max 15MB)
Please share a clear, closeup image of your bare skin with no makeup in natural light. Please take this photo facing a window, not in direct sunlight. Please do not submit imagery taken at night with overhead lighting.
Upload File
Upload supported file (Max 15MB)
Is there anything else you want to tell me about your skin journey, routine, concerns, expectations?
What are you hoping to gain from your consultation?
Are there any dermal therapies or cosmetic treatments you're interested in?
Where are you based? (nearest city & country)
How did you hear about me?
Select an item (AU$)
*
Comprehensive Skincare Consultation via Zoom with Joanna Fleming - AU$145
I agree to the
terms & conditions
Proceed to Checkout
Thanks for submitting your form,
you'll
receive
an email response within the next 14 days.
$145
AUD
bottom of page