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Fillmed Peel Treatment Consultation

Fillmed is a globally recognized French brand specialising in medical-grade aesthetic solutions for skin rejuvenation, hydration, and visible anti-aging results. Trusted by dermatologists, aesthetic doctors, and clinical skincare professionals, Fillmed offers a science-based approach to improving skin quality at every level. Fillmed Peel treatments are non-invasive, customisable chemical peels designed to rejuvenate, brighten, and smooth skin with minimal downtime. Using gentler gluconolactone, they target fine lines, pigmentation, and dullness, making them suitable for all skin types. 

Date of Birth
Day
Month
Year
Skin Concerns (please tick)
What skin care products are you currently using? (please tick)
How would you describe your skin?
Are you currently under the care of a gp?
Yes
No
Are you on any medication, either topical or oral?
Yes
No
Have you used any products containing topic Retinoids or Vitamin A?
Yes
No
Do you have any allergies to food/medication?
Yes
No
Do you have an autoimmune disease?
Yes
No
Are there any other aspects of your health that have not been identified above and we should be made aware of?
Yes
No
Do you have any chronic or serious medical illnesses? (example: diabetes, heart disease, epilepsy, blood disorders, cancer.
Yes
No
Do you smoke?
Yes
No
Are you prone to coldsores?
Yes
No
Do you have an allergy to latex?
Yes
No
Do you have eye sensitivities?
Yes
No
Are you allergic to aspirin?
Yes
No
Do you tan regularly (in the sun or tanning beds)?
Yes
No
Have you ever had a peel before?
Yes
No
Have you received a face peel in the last 14 days?
Yes
No
Are you claustrophobic?
Yes
No
Are you epileptic?
Yes
No
Have you ever taken a reaction to a facial or body treatment/product before?
Yes
No
Have you received any laser treatments in the last 4 weeks?
Yes
No
Have you had any facial waxing in the last 7 days?
Yes
No
Have you/or are you going to be exposed to the sun?
Yes
No
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