Ageing factors

What is anti-ageing medecine ?

"Anti-age solutions" concept

"Anti-age solutions" follow-up

Anti-age therapies

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On-line Consultation
Attention, this free consultation is meant to provide you with an orientation regarding therapeutic opportunities. This could in no way replace a face-to-face consultation, that has always to take place. The data you will transmit will be processed in a strictly confidential way and will be used to no other purpose than your information.

For an consultation about wrinkles and aesthetic, click here.



Anti-age consultation.

- Personal data
Nom :
Sexe :
City :
Telephone :
First name :
Age :
Country :
E-mail :


- Personal data

Size : (cm)
Smoker : no yes
Weight : (Kg)
From : (years)



Answer with a value from 1 to 4
1 = never
2 = a little
3 = moderately
4 = much

- General questions

Have you ?
loosening eyelids ? 1    2    3    4   
Crow's-foot wrinkles ? 1    2    3    4   
frontal wrinkles ? 1    2    3    4   
wrinkles between eyebrows ? 1    2    3    4   
wrinkles around the mouth ? 1    2    3    4   
bitterness wrinkles ? 1    2    3    4   
face skin loosening ? 1    2    3    4   
thinning lips? 1    2    3    4   
brown stains in the face ? 1    2    3    4   
brown stains on the hands ? 1    2    3    4   
brown stains in the neckline ? 1    2    3    4   
Un-aesthetic nasogenic wrinkles ? 1    2    3    4   
Scars ? 1    2    3    4   
Acne ? 1    2    3    4   
Upper lip wrinkles and small wrinkles ? 1    2    3    4   
unclear complexion ? 1    2    3    4   
wrinkled neckline ? 1    2    3    4   
Cellulitis ? 1    2    3    4   
saddlebag thighs ? 1    2    3    4   
un-aesthetic fat mass
on the internal face of knees ?		 1    2    3    4   
un-aesthetic fat mass
on the internal face of thighs ?		 1    2    3    4   
un-aesthetic fat mass
on the hips ?		 1    2    3    4   
un-aesthetic fat mass
on the stomach ?		 1    2    3    4   
un-aesthetic fat mass
on the chin ?		 1    2    3    4   
un-aesthetic fat mass
on the arms ?		 1    2    3    4   
- Free zone
Remarks or particular signs of ageing to be mentioned
 

AntiAgeSolutions | Chaussée d'Alsemberg, 995 - 1180 UCCLE | 19, Cour Saint-Antoine 4000 - Liège | (32) 02 647 59 30
contact@antiagesolutions.be
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