Skincare Consultation
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Today's Date
-
Month
-
Day
Year
Date
Intro/History
What are 2 or 3 things you'd like to be different about your skin? Are there any major goals or are you just looking to improve overall skin health?
Can you walk me through your current morning and evening routine?
Realistically, do you think you could be consistent with a routine?
Have you had facials or other skin treatments before? Peels, microneedling, botox, etc. Please list and tell me about how long ago.
Health and Allergies
What is your current age?
Are there any ingredients you know you're allergic or sensitive to?
Do you use oral contraceptives currently or have you used them in the past 1-2 years?
Are your periods regular
Are you easily sunburned? Do you have a history of sun exposure?
Are you using any medications? Do you have any ongoing health issues? Recent surgeries or medical treatments?
Are you pregnant, trying to get pregnant or nursing?
Do you smoke?
Lifestyle
Dos your job or lifestyle require that you work/play outdoors?
Do you wax your facial skin on a regular basis?
Describe your diet, do you consume a lot of alcohol, fat, sugar, dairy or red meat?
How is your water intake?
Skin Type
At the end of the day, what is your skin like? Dry and flaky or oily and shiny?
Does your skin behave differently in different seasons?
Does your skin feel tight right after you wash it?
How has your skin changed as you've gotten older? (i.e. oily as a teenager, but dry now, no breakouts until 30s, etc.)
Skin Conditions
If you have breakouts, how often do they appear? Are they in clusters? Or here and there?
Is your skin usually red? Is it warm to the touch?
Does your skin feel rough or smooth?
Do you have broken capillaries visible under the skin?
Do you have any type of dark spots (other than natural freckles)? If so, do you know what caused them? (i.e. melasma, acne scarring, sun damage, etc.)
Does your skin sting when you apply certain products?
Recommendations
Do you prefer to focus on professional treatments, a homecare plan or both? Is there a certain treatment you are most interested in?
If you are looking for product recommendations, do you have a certain budget in mind? For reference, most clients spend around $225-250 on their initial routine. You can spend $40 on a minimalist routine or just focus on a couple treatment products. We can talk more about your goals and priorities, but it helps me to know what you're ready to invest.
Submit
Should be Empty: