Omnilux light therapy treatment

Online Consultation Form

Please complete the following form to start your skincare consultation with our expert skin specialists.

Once completed and you have been assessed for suitability by our expert specialists, you will receive product recommendations in an email. The hidden Dermaquest and Environ products will then be unlocked and visible for you to browse and buy in our exclusive online store. 

Please note, online consultations are approved Mon-Fri 9-5pm. If completed after 3pm then you will be assessed on the next working day. Any questions, please email

* = required information

About You

First Name *
Last Name *
Date of Birth *


Line 1 *
Line 2
Town *
County *
Postcode *

Contact Information

Email Address *
Confirm Email Address *
Preferred contact method Email Phone

Medical History

We need this information in order to assess your Environ and Dermaquest product suitability. This sensitive information is encrypted in our database, and will be deleted 48 hours after we have contacted you. It is not used or kept for any other purpose.

Do you have any Medical Conditions? *YES   NO  
If yes, please provide details
Are you taking any medication? *YES   NO  
If yes, please provide details
Are you taking any supplements? *YES   NO  
If yes, please provide details
Do have any allergies? *YES   NO  
If yes, please provide details
Are you allergic to nuts? *YES   NO  
Are you currently taking aspirin? *YES   NO  
Are you currently pregnant or breastfeeding? *YES   NO  

Your Skin

Do you have any of the below skin conditions?Psoriasis Eczema Rosacea Acne
Other (specify)
Have you ever experienced skin sensitivity to any products or facial treatments? * YES   NO  
Have you had any advanced facial treatments in the last 6 months?Laser IPL Peels Microdermabrasion Injectables Micro needling
Other (specify)
Do you have any previous history of skin cancer? * YES   NO  
Would you burn within 20 minutes in the sun without SPF? * YES   NO  
What is your skin type? * Very Fair Fair Cream/White
Olive Dark Brown Black
How do you find your skin? * Oily Combination Sensitive
Dry Normal
Please state your skin concerns (if any)

Other Information

Please state any products you are currently using *
What are your expectations from using products? *
Products interested in purchasing
How did you hear about

I confirm to the best of my knowledge that the answers given are correct and I have not withheld any information for the use of DermaQuest and Environ products. I understand that results cannot be guaranteed. I will inform if any of this information changes. *

* = required information

Once your consultation and account has been approved, you will be able to browse and buy Dermaquest and Environ products from the website. These categories are exclusively available to our approved clients.

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FREE online consultation with official Dermaquest and Environ stockist

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