Universkin Medical Skin Care Consultation

First Name*

Last Name*

Email Address*

Phone Number*

Date of birth*

Location

Address Line*

Country*

City*

State / Province / Region*

Zip/Postal code*

Photos of the area of concern (Front View, Back View ,Left Side View, Right Side View)*

Your photo will be added to the Universkin's platform for image analysis and Dr. Mulholland and his team will adjust your diagnostic if needed before preparing your personalized formula.

I, hereby consent to the use and storage of my photo and clinical details by Universkin, on the SkinXs platform to optimize my skin analysis and ensure an efficient communication with Dr. Mulholland as part of the prescription care. I am also informed that Universkin might use my image for clinical research purposes while carefully masking my eyes and/or distinctive signs, according to the applicable regulation. In such case: I am informed that I can withdraw my consent to such processing at any time by informing Universkin of such decision and/or through the procedure set forth in Universkin’s Terms & Conditions.*

I acceptI don’t accept

Skincare Concerns

What is your complexion?
Olive/Tanned skinProne to pigmentationNone of the above

Do you have dry skin?
YesNo

Does your skin feel tight in the morning?
YesNo

Do you have any of the following?
CystsBlackheadsRoughnessHyperkeratinization

Does your t-zone (forehead, nose & chin) feel oily in the morning?
YesNo

Do you have skin discolouration/brown pigmentation?
YesNo

Are you prone to acne spots or wrinkles
YesNo

If applicable, let us know if you are currently pregnant. Active ingredients like Retinol or Arbutin cannot be prescribed to pregnant women.*
Yes, I am pregnantNo, or not applicable

Are you going to spend time in a warm environment with high UV exposure in the next few weeks (ex: ski trip)? The doctor might decide to not exfoliate your skin in case of very high UV exposure.*
YesNo

Are you allergic to Asprin? If so, we will avoid Salicylic acid.*
YesNo

Are you allergic to Soy? If so, we will avoid Isoflavone.*
YesNo

Do you tolerate exfoliating active ingredients such as Vitamin C, Retinol or Glycolic acid? A reaction to these ingredients can be seen on the skin as redness, causing heat and itchiness or in extreme cases, swelling. Some exfoliants contain powerful actives that can cause sensitivity on certain skin types.*
YesNoI am not sure

Did you ever suffer from Acne Rosacea (red skin discoloration, broken vessels, or ruddy complexion)? Acne Rosacea is a hypersensitive skin condition that appears as inflamed dry, patches. Unlike acne, there are neither blocked pores, nor scars left.*
YesNoI am not sure

Do you suffer from brown discolouration. hyperpigmentaiotn, brown spots or melasma?*
YesNo

Do your concerns include wrinkles, skin laxity, and sun damage?*
YesNo

Do your skin concerns include enlarged pores, acne scars, and/or irregular texture?*
YesNo

Have you been treated for breast cancer or glandular cancer? We will adapt your formula to adapt to your specific needs.*
YesNo

Skincare Packages

Your own personalised Universkin™ Serum P - 15ml 0.52Fl.Oz. Universkin™ Serum P is a multi-purpose soothing serum, a patented combination that helps regenerate and repair epidermal skin. Freshly blended with pure, pharmaceutical grade active ingredients, it targets your specific skin needs. Dr. Mulholland will select the right active ingredients at the right concentrations.

Option 1 - $369: Two serums bottles AM/PM - savings of $89 *shipping includedOption 2 - $229: One serum bottle *shipping includedI am not interested

Hyaluronic acid serum booster Universkin™ H - 15ml 0.52Fl.Oz. This serum is a supercharged powerful hyaluronic shot that can be used alone or blended with your serum. Dr. Mulholland recommends to mix it with your personalized serums to amplify hydration, firmness and plump your skin. Suitable for all skin types. 1.4% of pure hyaluronic acid

Add Universkin™ H Serum for $69 *shipping includedI am not interested

Universal oil Nexultra™ O - 100ml 3.3Fl.Oz. Soothes, purifies, cleanses, removes make-up Nexultra™ O is a multi-purpose cleansing and soothing oil, a patented combination of biomimetic peptides, olive oil, plant CO2 extracts and Omega-3, which helps to cleanse and repair the skin. It does not only cleanse and hydrate your skin, it also soothes it at the same time. It can be applied not only on your face but also on the eye contour, hair and scalp.

Add Nexultra O for $69 *shipping includedI am not interested

Dr Mulholland offers the complete set (AM/PM and the H serum plus the O cleanser) for $425 (a total savings of $171) *shipping included

Yes, I want the complete setNo, I prefer to order the products individually as already selected

This package includes:

Two serums bottles AM/PM
One Universkin™ H hyaluronic acid serum booster
One Nexultra™ O universal oil cleanser

Payment will only be processed after your virtual consultation. Your credit card will be processed securely directly from our office or PayPal, a secure payment platform can be used. There is no charge for you Universkin Virtual Consultation with our Senior Universkin Medial Skin Care Coordinator. You Universkin bespoke, customized, medical skin care can then be formulated, compounded and shipped directly to you from the comfort and safety of your own home.

Book a Virtual Consultation

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