SKIN ASSESSMENT

FILL OUT SKIN ASSESSMENT FORM FOR A CUSTOMIZE SKIN & WELLNESS ANALYSIS. THIS WILL ALLOW OUR SKIN EXPERTS TO CURATE THE BEST REGIMEN FOR YOUR CONCERNS.

Name

Gender

Male‎ Female‎

Age

Email
Have a copy of the submitted Online Questionnaire sent to the user

Skin Type

Normal‎ Dry‎ Oily‎ Combination‎ Other: ‎

Skin Sensitivity

Normal-no sensitivity‎ Sensitive‎ Very Sensitive‎

Skin Breakouts

Acne Occasional Pimples Cyclical Breakouts Rosacea Other: ‎

Do you use sunscreen daily?

What are your skin concerns?

Are you pregnant or nursing?

Do you drink 6-8 glasses of water a day?

What's your current skin regimen?

Are you allergic to any ingredients, medications, or have any food allergies?

How often do you get a facial?

Once a month Not as often as I should Never had a facial

Would you take out 30-45 minutes a week for yourself?

Do you have 5- 10 minutes a day for your skincare needs?

YES‎ NO‎ SOMETIMES‎

Do you use vaginal care products?

YES‎ NO‎ I'M OPEN‎

Do you use body care?

YES NO

Are you taking beauty supplements?

YES‎ NO‎ I'M OPEN‎

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