The Bright Side Client Store Access Request

Want access to the best skin care for your skin? No problems! Tell us a little bit about your skin and how to contact you to ensure we make sure the best product for your skin is available to you.

The Bright Side Client Store stocks Dermaviduals and Prologic Skincare ranges that are skin therapist prescription products, and so, we need to make sure that these products are suited to your skin before dispensing. Leave your message and we'll get back to you shortly.

Full Name *

Email *

Phone *

Are you an existing Bright Side Client? *

Have you used Dermaviduals or Prologic Skin Care previously? *

Dermaviduals
Prologic Skin Care
Both
No

Do you have any of the following skin health concerns?

Acne
Rosacea
Pigmentation
Eczema
Psoriasis
Dermatitis
Keloid Scars
Lupus
Scleraderma
Other

Are you currently taking any medications? (Please list any as oral or topical use)

Do you have any allergies or intolerances to products in skincare or food ingredients?

Have you ever had any reactions to skin care products? If so, what products or ingredients? *

Do you need any assistance with your skin care prescription? (i.e. not sure if the skin care products are best suited to your skin or need an adjustment to your skin product prescription) *

Would you prefer to be contacted by phone or email? *

Email
Phone

Thanks you :)

Thank you for submitting your form. Krystyna will be in touch with you soon.

Thanks you :)

Thank you for submitting your form. Krystyna will be in touch with you soon.