Please fill in the data and press the submit button to send your profile to our medical team for an expert opinion. You can also email your skincare concern to info@skinclub.com.my * Required fields               Name: * E-mail Address: * Gender: * Male Female Telephone Number: * Age: * How did you find our website? * Friends and Family Newspapers Advertisements Other Websites Occupation: * How should we contact you? * Phone E-mail                 SKINCARE CONCERN:         Skincare: Total Makeover: Hair removal Tattoo removal Sweat reduction Spider vein reduction Stretch marks Slimming Cellulite Anti aging   Acne Pigmentation Scars Dull texture Open pores Facial recontouring Chin, lip & nose augmentation   Age Eraser: Facial lines & wrinkles Skin firming               LIFESTYLE:     Sun exposure - normal Sun exposure - high Smoking Under constant stress Poor nutritional habits Skin condition aggravating stress Avoiding people due to skin condition                   Previous cosmetic procedures: Any known allergies: Any medical or surgical conditions: Any other information:         BY SUBMITTING THIS FORM I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE FOLLOWING: This questionnaire submitted online cannot substitute for the completeness of an in-person consultation with licensed professional doctors. The medical doctors at Skin Club and DermaGenesis analyze and suggest treatments or advices solely on the completeness and accuracy of the information provided by you. Since medicine is not an exact science and newer discoveries are possible, the information provided here might be in conflict. Consumers are advised to seek professional medical advice as and when necessary.       Privacy Policy Contact Us Online Consultation Online Appointment   Copyright © 2009 Skin Club. All Rights Reserved.

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