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info@blackwaterprivateclinic.com

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Alumier Registration

Please fill this registration form, afterwards, you will be redirected to the Alumier MD Skin Care website

*Name

*What are your skin care concerns?

Acne

Eczema

Anti-Aging

Psoriasis

*Date of Birth

*Skin Type

Dry

Oily

Combination

Sensitive

Are you Pregnant or Breastfeeding? (Vitamin A/Retinol) is contraindicated in these groups.

Yes

No

*Blackwater Private Clinic offers a Bespoke Prescription Skin Service. Please describe your skincare needs, including Allergies and Medication history:

*Email

Phone Number

*For Customers in the Republic of Ireland, please contact the clinic directly to complete your order.

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Thank you for connecting with us. We will respond to you shortly.

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Alumier Registration

Please fill this registration form, afterwards, you will be redirected to the Alumier MD Skin Care website

*Name

*What are your skin care concerns?

Acne

Eczema

Anti-Aging

Psoriasis

*Date of Birth

*Skin Type

Dry

Oily

Combination

Sensitive

Are you Pregnant or Breastfeeding? (Vitamin A/Retinol) is contraindicated in these groups.

Yes

No

*Blackwater Private Clinic offers a Bespoke Prescription Skin Service. Please describe your skincare needs, including Allergies and Medication history:

*Email

Phone Number

*For Customers in the Republic of Ireland, please contact the clinic directly to complete your order.

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Address

1, The Square, Moy
BT71 7SG Co. Tyrone

Address

+44 (0) 28 8775 5880
info@blackwaterprivateclinic.com

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