FP Skin Bespoke Skin Consultation Form
Please complete with as much detail as possible in order for us to provide an effective 360 skincare plan for you.
Name
*
First Name
Last Name
Email
*
example@example.com
Age
*
Phone Number
Please enter a valid UK phone number
Are you on any medication and/or suffer from any health problems?
*
Please list all
Do you suffer from any allergies?
*
Please list all
Do you take supplements? If so, what supplements are you currently taking?
*
Are you currently pregnant, and/or breastfeeding?
*
Describe your lifestyle: diet, stress levels, exercise regime, alcohol intake, sleep etc
*
Please list all
Do you/have you suffered from any skin conditions, including but not limited to: cold sores, rosacea, skin cancer, erythema, pigmentation/discolouration? If yes, please provide details as to triggers causing them, when they occur, etc:
*
Describe your current skincare routine including products and brands, and the order that you use them in: e.g. your AM routine and your PM routine
*
Please list all, including AM and PM products
What are your main concerns with your skin?
*
Please list all
What skin type do you believe you have?
*
Oily
Dry
Combination
Do you experience any redness, itching, and/or burning with your skin?
*
Yes
No
Do you wear SPF (sunscreen) minimum factor 30 on a daily basis?
*
Yes
No
No, but my moisturiser and/or make-up includes SPF in
How many times a week do you exfoliate your skin? This includes exfoliating toners, enzyme peels, and scrubs:
*
0x a week
1x a week
2-3x a week
4-5x a week
Everyday
Upload photos of your skin here - please ensure your photos are filter and make up free, and are taken in natural/good lighting. Full frontal and full sides of your face
*
Browse Files
Drag and drop files here
Choose a file
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What are your skincare goals?
*
Do you have any events coming up that may affect your skincare journey, or that you would like to work towards? If so, please state the event(s) and the date(s) so we can effectively plan for it:
*
What is your budget in order to achieve your skincare goal(s)?
*
£100-£150
£150-£200
£200-£250
No budget
Would you prefer to be contacted via email, via Zoom video call, or both?
*
Email
Zoom call
Email and Zoom call
Please sign here to confirm that you have answered all of the questions in full detail, and to the best of your knowledge.
*
Payment to submit consultation & receive a bespoke skin plan:
*
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