Safety Disclosure Form Safety Disclosure Form Due to the level of active ingredients in our skincare ranges some important questions must be answered prior to shopping online. Should any products be unsuitable we will contact you to discuss a more suitable option or offer you a refund or exchange. Please note that all fields are mandatory. Name* First Last To ensure we can process your order as quickly as possible, please make sure this matches the name on your order.Are you currently pregnant or lactating?* Yes No Do you suffer from allergies to any of the following? No Milk Apples Citrus Grapes Aloe Vera Aspirin Any Essential Oils Please check all that apply.Have you previously used any of the following product ranges?* No Aspect Teen Aspect Cosmedix Skin Medica Société Elemis Mineralogie Please check all that apply.Are you currently on any of the following medication?* No Accutane Retin A Renova Adupalene Please check all that apply.Are you using any other prescription skin products?* Yes No Please list the other prescription skin products you are using.Do you have any other skincare concerns?* Yes No Please describe your skincare concerns.NameThis field is for validation purposes and should be left unchanged.