Skin Test

Please 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.

**The Eyrebrushed SkinTest is designed to help new-to-Eyrebrushed clients. If you are already an Eyrebrushed client and need help with your routine, just pop us a message for a follow up.

Name *

First

Last

Email *

Phone

What age are you?

Under 18
18 - 25
26 - 35
36 - 45
Over 45
I'd rather not say

Do you have any medical issues? *

Please describe any medical issues here:

Are you currently taking any medication? *

Please list your medications here:

Are you pregnant, planning a pregnancy, or breastfeeding? *

Do you have any allergies? *

Please list your allergies here:

How much water do you drink per day?

Less than 1 litre
1 -2 litres
2-3 litres
3+ litres

How would you describe your skin: *

Dry (flaky, uncomfortable)
Oily
Combination of both dry & oily
Unsure / I don't know

Is sensitivity a concern? *

Are you sensitive to any products? *

Which products?

Are you sensitive to any foods? *

Which foods?

Is redness a concern? *

Describe your redness on a scale of 1-10 (10 being extremely red)

Redness: 5

Do you experience some tightness in the skin (post shower or cleansing): *

Yes
No
Unsure / I don't know

Do you suffer with blackheads? *

Yes
No
Unsure / I don't know

Do you have underlying congestion? *

Yes
No
Unsure / I don't know

Do you get breakouts? *

Is pigmentation / sun damage (brown or red spots) a concern? *

Yes
No
Unsure / I don't know

Are lines and/or wrinkles a concern? *

Is skin laxity (sagging skin) a concern? *

How would you describe your skincare routine? *

No routine
Basic routine
Well established routine

Which brand(s) of skincare products do you currently use? *

Are results more important than budget? *

Describe your budget for your recommended skincare routine: *

Under €100
€100 - €200
€200+

You 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.

Is there any additional information you wish to share about your skin?

Last step! Once you tap CONSENT & SUBMIT below, your answers will be stored & sent.

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. Please do note that we respond to Skin Tests in the order they arrive. During very busy periods (like lockdowns!), result emails can be delayed.

Consent *

I consent to having Eyrebrushed.ie / Eyrebrushed Skin Clinic store my submitted information so they can assess my skin and provide accurate recommendations. *

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