Alchemy Biolabs | Personalised Skin Consultations

Client details

Full Name

Date of birth

Phone

Skin and health history

Main skin concern

Current products, prescriptions, supplements, or treatments

Known allergies or past product reactions

Safety checks

I am pregnant, breastfeeding, trying to conceive, or unsure.

I am currently under GP, dermatologist, or specialist care for this concern.

I consent to submitting skin, scalp and hair photos for review as part of my consultation.

I have declared any known allergies or sensitivities, including to ingredients, fragrances or medications.

I have listed any current or past prescriptions, medications or treatments relevant to my skin, scalp or hair.

I understand Alchemy Biolabs provides skin, scalp and wellbeing guidance and formulation advice, not emergency care or a medical diagnosis.

I understand I may be referred to a GP or dermatologist if symptoms suggest medical assessment is needed.

Consent statement

By submitting this form, I confirm the information I provide is accurate to the best of my knowledge. I consent to Alchemy Biolabs using it to prepare personalised skin, scalp, wellbeing and product guidance within the scope of a biochemist-led consultation. I understand this is biochemist-led guidance, not medical advice from a doctor or GP.

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Skin history, safety, and consent.

Skin history, safety, and consent.