Please enable JavaScript in your browser to complete this form.Welcome - Step 1 of 27Please answer the following questions so we can accurately recommend a skincare routine for you. Please be aware that for more complicated skin concerns we may recommend a follow up online consultation or skin scan in clinic.Begin TestName *FirstLastEmail *PhoneNextWhat age are you?Under 1818 - 2526 - 3536 - 45Over 45I'd rather not sayPreviousNextDo you have any medical issues? *YesNoPlease describe any medical issues here:PreviousNextAre you currently taking any medication? *YesNoPlease list your medications here:PreviousNextAre you pregnant, planning a pregnancy, or breastfeeding? *YesNoPreviousNextDo you have any allergies? *YesNoPlease list your allergies here:PreviousNextHow much water do you drink per day?Less than 1 litre1 -2 litres2-3 litres3+ litresPreviousNextHow would you describe your skin: *Dry (flaky, uncomfortable)OilyCombination of both dry & oilyUnsure / I don't knowPreviousNextIs sensitivity a concern? *YesNoPreviousNextAre you sensitive to any products? *YesNoWhich products?PreviousNextAre you sensitive to any foods? *YesNoWhich foods?PreviousNextIs redness a concern? *YesNoDescribe your redness on a scale of 1-10 (10 being extremely red) Redness: 5PreviousNextDo you experience some tightness in the skin (post shower or cleansing): *YesNoUnsure / I don't knowPreviousNextDo you suffer with blackheads? *YesNoUnsure / I don't knowPreviousNextDo you have underlying congestion? *YesNoUnsure / I don't knowPreviousNextDo you get breakouts? *YesNoPreviousNextIs pigmentation / sun damage (brown or red spots) a concern? *YesNoUnsure / I don't knowPreviousNextAre lines and/or wrinkles a concern? *YesNoPreviousNextIs skin laxity (sagging skin) a concern? *YesNoPreviousNextHow would you describe your skincare routine? *No routineBasic routineWell established routinePreviousNextWhich brand(s) of skincare products do you currently use? *PreviousNextAre results more important than budget? *YesNoPreviousNextDescribe your budget for your recommended skincare routine: *Under €100€100 - €200€200+PreviousNextYou are now invited to submit some photos of your clean skin taken in natural light: Click or drag files to this area to upload. You can upload up to 5 files. Please click Next if you wish to continue without submitting photos.PreviousNextIs there any additional information you wish to share about your skin?PreviousNextLast step! Once you tap CONSENT & SUBMIT below, your answers will be stored & sent to Emma.Be sure to keep an eye out in your inbox for two emails from Eyrebrushed. The first is a confirmation that we received your answers & that we have the right email. (If you don't receive this email within 30 mins of submitting, pop us a message so we can check your email.)The second email you will receive from us will be your personalised skincare routine & recommendations from Emma. These personalised emails usually take 48 hours to arrive.Consent *I consent to having Eyrebrushed.ie / Eyrebrushed Beauty & Skin Clinic store my submitted information so they can assess my skin and provide accurate recommendations. *PreviousSubmit