Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
When is your birthday?
Instagram handle
How would you describe your skin type?
Oily: Skin appears shiny & pores are very viable
Normal: Skin is neither dry, nor oily, or sensitive.
Combination: Skin feels dry or normal in areas & oily in others (forehead, chin, nose)
Dry: Skin feels dry and tight & pores are invisible
Sensitive: Skin is delicate & responsive to changes
What is your main skin concern?
Fine lines & Wrinkles
Dullness/lack of radiance
Dehydration
Texture
Large/open pores
Uneven skin
What is your main skin goal?
Bright, radient skin
Clear, even tone skin
Replenished, hydrated skin
Plump, tight skin
Smooth, refined skin
Do you wear makeup?
Yes
No
Describe your dream skin.
Reduced and softened lines
Refined pores
Revitalized under eye area
Controlled shine
None of the above
Do you want to take the Hair Quiz?
Yes, I want to take the Hair Quiz!
No, Take me to my new skin routine
I already took the quiz
Email
example@example.com
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