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Skin Care Questionnaire/Cuidado Sobre tu Piel
1
Contact information/Información de contáctacto.
Nombre
Apellido
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2
Birth Date/Fecha de cumpleanos
-
Month
Day
Year
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3
Gender/Sexo
Please Select
Male
Female
N/A
Please Select
Please Select
Male
Female
N/A
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4
E-mail/Correo Electronico
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5
Phone Number/Numero de Telefono
Area Code
Phone Number
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6
1. How would you describe your skin when you wake up in the morning? /Cómo sientes tu piel al despertarte?
oily/con exceso de grasa
dry or lacking moisture/reseca y falta de hidratación
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7
2. During your nighttime regimen, what is your main objective with regards to your skin? (check all that apply)/Durante tu regimen antes de dormir, cual es tu objetivo para tu piel?
making sure my skin is sufficiently moisturized /hidratar la piel
making sure I remove excess oil and dirt /eliminar el exceso de grasa y suciedad
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8
3. What is your biggest concern regarding your skin? / Cuál es tu mayor preocupación con respecto a tu piel?
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9
Additional Comments
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