Class Details

Class Type

Class Content

Speaker

At Capacity

TRUEFALSE

Day

Date

Start Time

End Time

Region

Venue

Class is at Full Capacity

We are sorry but this class is at full capacity.

Please select another class or call 0800 865 432 or email info@lgfb.co.nz

Edit section title

Please fill in your details for all the fields marked * to enable your registration to be completed. You do not need to be referred to register for a class. If you need any help completing your registration please call 0800 865 432.

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. If you don't have an email please call 0800 865 432

Mobile Phone

02XXXXXXXXX

Street No and Address

City

Region

Postcode

How did you hear about Look Good Feel Better?

Is this your FIRST time registering for a LGFB class?

Registration Details

Date of Birth

dd/mm/yyyy

Gender

Ethnicity

What type of cancer are you being treated for?

We like to thank the wonderful people who share our services. If you know the details of this person, please complete below. It is not a problem if you don’t know, or were not referred – please leave blank.

Referrer/Health Professional Name

Referrer/Health Professional Email

If email is not unknown, leave blank

Community Registration

Any special requirements eg wheelchair access?

Would you like to bring a Support Person?

Support Person Name & Contact Details (Mobile/Email)

Pack Registration Details

The following information assists us in providing the best products to suit you in your kit of donated skincare and makeup. Please complete all categories

Please be aware that cosmetic, make-up and skincare products are provided and used at Look Good Feel Better classes. 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. Please read our Privacy Policy for more information on how we use your information.

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

Preferred Eyeshadow Shade

Preferred Lipstick Shade

Skin Tone

Eyebrow Colour

As you have registered previously online we have your information. Please proceed to submitting your registration.

Are there any questions you would like to submit to be answered during the Q&A ?

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

If you have any questions please call 0800 865 432