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Complete Your SkinBetter Science Consultation

To purchase selected SkinBetter Science products online, please complete the consultation form below. Your information will be reviewed by the Newderm Medical clinical team to ensure the products are appropriate for your skin.

Complete this consultation form to request access to purchase SkinBetter Science products online. Your information will be reviewed by the Newderm Medical clinical team.

Step 1 of 4

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Personal Details

Please provide your contact details so our clinical team can review your consultation and contact you if necessary.

Name(Required)

First Last

Email(Required)

Phone(Required)

Skin History

Have you used SkinBetter Science products before?(Required)

Yes

No

Are you currently using any retinol, retinoid or Vitamin A products?(Required)

Yes

No

Not sure

Which retinol, retinoid or Vitamin A product(s) are you currently using?

Please include the brand and product name, if known.

How frequently do you use these products?(Required)

Every day

Every other day

3–4 times per week

1–2 times per week

Less than once per week

Other

Please specify how frequently you use the product(s).(Required)

Skin Concerns

What are your main skin concerns?(Required)

Fine lines & wrinkles

Pigmentation

Sun damage

Acne or breakouts

Acne scarring

Redness / Rosacea

Sensitive skin

Dryness

Uneven skin tone

Loss of firmness

Other

Select all that apply.

Please tell us about your other skin concern.(Required)

Medical & Safety Questions

Have you ever experienced a reaction to a skincare product?(Required)

Yes

No

Please provide details of the reaction.(Required)

Do you currently have any diagnosed skin conditions?(Required)

Yes

No

Please provide details of any diagnosed skin conditions.(Required)

Are you currently pregnant or breastfeeding?(Required)

Yes

No

Not applicable

Current Skincare Routine

Please list any skincare products you currently use.(Required)

Please include cleansers, serums, moisturisers, prescription products, SPF and any active ingredients, where possible.

Photographs (Optional)

You may upload up to three clear, recent photographs taken in natural light, without makeup or filters. Photographs are optional but may help our clinical team review your consultation.

Front View

Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.

Left Side

Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.

Right Side

Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.

Consent

Accuracy Confirmation(Required)

I confirm that the information provided in this form is accurate and complete to the best of my knowledge.

Professional Review(Required)

I understand that SkinBetter Science products require review by a skincare professional before purchasing approval can be granted.

Approval Confirmation(Required)

I understand that submitting this consultation form does not guarantee approval to purchase SkinBetter Science products.

Privacy and Photograph Consent

I consent to Newderm Medical processing the information and photographs submitted in this form for the purpose of reviewing my SkinBetter Science consultation, in accordance with the Newderm Medical Privacy Policy.

Please answer each question as accurately as possible. Photographs are optional, but they may help our clinical team provide a more informed review.

Submitting this form does not guarantee approval. We will contact you by email once your consultation has been reviewed or if any additional information is required.

SkinBetter Science Consultation

CONTACT

t/ 083 111 0202
e/ reception@newderm.ie

LOCATIONS

Newderm Medical 16 Stilorgan Park Avenue, Dublin

CLINIC HOURS

Mon closed
Tues 10am - 6pm
Wed closed
Thur:10am - 6pm
Fri: 10am - 6pm
Sat: 10am - 6pm
Sun closed

TREATMENTS

Injectables
Laser Medicine
Cosmetic Dermatology

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