RE-ORDERExisting customers ZO products re-order form. Name * Email * Phone * Have you had a face-to-face or virtual consultation from Health + Harmony Clinic? * Yes No Have you had any problems with our product routine? * Are there any changes in your medical allergies or conditions? * Are you pregnant – trying to become pregnant or Breastfeeding? * Yes No Are you currently taking any prescriptive medication including topical creams? * Yes No If yes, please advise the medication you are currently taking: Are you taking any vitamin supplements? * Yes No If yes, please advise the vitamin supplements you are currently taking: Are there any other particular problem areas you are concerned about? * Please tick the products you would like to re-order: GSR: Cleanse & Exfoliate & Tone Exfoliating Cleanser Normal / Oily 200ml Hydrating Cleanser Normal / Dry 200ml Gentle Cleanser 200ml Balancing Cleansing Emulsion 200ml Exfoliating Polish 65g Dual Action Scrub 116g Complexion Renewal Pads 60 pads Oil Control Pads Acne Treatment 60 pads Calming Toner 180ml Exfoliating Accelerator Prevent & Correct: Acne Acne Control 60ml Correct & Conceal Light 2.5g Correct & Conceal Medium 2.5g Complexion Clearing Mask 90g Prevent & Correct: Anti-Aging 10% Vit C Self Activating 50ml Daily Power Defence 50ml Growth Factor Serum 30ml Instant Pore Refiner 29g Radical Night Repair 1% Retinol 60ml Enzymatic Peel 50ml Wrinkle Texture Repair 0.5% Ret 50ml AOX Illuminating Serum 50ml Prevent & Correct: Brightening Brightalive 50ml Retinol Skin Brightener 1% Ret 50ml Retinol Skin Brightener 0.5% Ret 50ml Retinol Skin Brightener 0.25% Ret 50ml Prevent & Correct: Redness Rozatrol 50ml Protect & Sunscreen Daily Sheer Broad Spectrum SPF 50 45ml Smart Tone Broad Spectrum SPF 45ml Sunscreen + Primer SPF 30 30ml Broad Spectrum SPF 50 118ml Sunscreen + Powder Deep SPF 30 Sunscreen + Powder Light SPF 30 Sunscreen + Powder Medium SPF 30 Gel Sunscreen Broad Spectrum SPF 50 Sheer Fluid Broad spectrum SPF 50 Supplementary: Eye, Hand, & Body, Hydration & Calming Eye Brightening Crème 15g Intense Eye Crème 15ml Growth Factor Eye Serum 15ml Cellulite Control 150g Body Emulsion 240ml Hydrating Crème 113ml Renewal Crème 50ml Recovery Crème 50ml Firming Serum 47ml Soothing Ointment Program / Kits Daily Skincare Program - 4 items Anti-Aging Program - 5 items Aggressive Anti-Ageing Program - 6 items Completion Clearing Program - 4 items Skin Normalising System - 5 items Skin Brightening System Non HQ - 5 items Skin Brightening & Texture Repair Program - 4 items Please add notes or any additional product required not on the list here. Please check “Yes” to confirm that you are happy for us to contact you to arrange payment and delivery. * Yes Contact me by * Email Text Phone Thank you!
