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14
Questions
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1
NAME
First Name
Last Name
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2
EMAIL
example@example.com
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3
PHONE NUMBER
Area Code
Phone Number
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4
BIRTHDAY
-
Date
Year
Month
Day
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5
INSTAGRAM OR FACEBOOK
Leave your Instagram handle or Facebook info below!
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6
SKIN TYPE
Dry
Sensitive
Normal
Combination
Oily
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7
SKIN CONCERNS
Sunspots
Age spots
Fine lines / wrinkles
Eczema
Psoriasis
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8
ACNE
YES
NO
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9
LARGE PORES
YES
NO
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10
DARK CIRCLES/ EYE BAGS
YES
NO
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11
SKIN CONCERNS
Uneven Tone
Texture
Oil
Fine lines/Wrinkles
Dullness/Brightening
Dark Spots
Dryness
Dehydration
Sensitive Skin
Pores
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12
SKIN GOALS
What do you want to mainly focus on changing
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13
WHATS YOUR SKIN CARE ROUTINE CURRENTLY
List the products you use as well
Huge
Large
Normal
Small
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14
HOW TO CONTACT YOU
Text Phone Number
Email
IG
FB
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