InstagramThis field is for validation purposes and should be left unchanged.Name*Email* Phone*Residence*ResidenceNSWQueenslandOther Australian statesInternationalWhat is your ethnicity?*What is your ethnicity?Caucasian / EuropeanAsianMiddle Eastern / LatinoIslander / indigenousOtherMixedHow long have you suffered from pigmentation?*How long have you had your skin concern?Less than 3 months3- 12 months12 to 36 monthsLonger than 3 yearsSkin concern*Skin concernMelasmaOther pigmentScarring (including acne)Skin rejuvenationRosaceaOtherUpload up to FIVE pictures of your concern in natural light with no makeup.* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, heic, jpeg, Max. file size: 2 MB, Max. files: 5. Photos & clinical information is treated with the utmost confidentiality. This form is designed to expedite your application process for an appointment with our clinicians. Following review by our clinicians, we may grant you an appointment, should you want to see us. If our team is not taking on new patients, we will suggest a practitioner that may assist you. What have you tried to address your problem?* Skin care Lasers Chemical peels Microneedling Injectables Others Anything else you might want to add?*
