Contact Details

First Name

Last Name

This will be used to send class details, so please make sure it is the Contact's email address

Mobile Phone

02XXXXXXXXX

Phone

Mailing Street

Mailing City

Mailing Postcode

Ethnicity

Registration Details

Look Good Feel Better is a programme designed to give you confidence and boost your self esteem. To assist us in providing the best product to suit you, please complete all categories:

WP Online Category

Skin Tone

Eyebrow Colour

Eye Colour

Hair Colour

Have you experienced hair loss?

Preferred Lipstick Shade

Preferred Eyeshadow Shade

Are there any products/brands that you should not use for health or medical reasons (including reasons related to your treatment)?

Referrer/Health Professional Name

Referrer/Health Professional Email

Date of Birth

dd/mm/yyyy

For what type of cancer are you being treated?

Have you ever attended a LGFB workshop?

How did you hear about LGFB?

Please be aware that cosmetic and skincare products are sent to you to be used during the Look Good Feel Better class. Look Good Feel Better is non medical and those wishing to attend a Look Good Feel Better class should consult their oncologist if they have any concerns regarding the products we use. A list of the brands donated is available on our website. The Cosmetic, Toiletry and Fragrance Association of New Zealand (CTFA) and member companies take their responsibility for the safety of cosmetics and toiletries very seriously. Safety substantiation of ingredients, either by manufacturers of raw materials, or by companies marketing products containing them, is based on rigorous scientific safety processes. Legislation requires any cosmetic product placed on the market to be safe under normal circumstances of use.

Thank you for taking the time to provide us with information, as it will help us ensure you get the most out of your Look Good Feel Better experience.

We will send you an email confirmation of your booking. If you do not receive one, please check your spam or please call 0800 865 432