The Skin Guru Consultation™️ Initial Investigation

Personal Details
Name*
If you would like to share your pronouns please enter here
Post code
Email address*
example@example.com
Mobile Number *
Age *
What is the main reason for your booking a Skin Guru Consultation™️?*
Medical Questions

This first section helps me check for anything that could prevent treatment, affect your skin and any adjustments I need to make when recommending solutions
I have allergies (skin / lifestyle)*

YesNo
I am pregnant or nursing/lactating*

YesNo
I am going through IVF, or trying to get pregnant?
I have been exposed to the sun or used a tanning bed in the last 3 weeks*

YesNo
I am currently using sunless tanning products*

YesNo
I am currently using or have used Accutane (isotretinoin) in the last six months*

YesNo
I am using any prescription or non-prescription retinoids (eg. retinol, Retin-A®, Tazorac®)*

YesNo
I am currently using prescription topical medication*

YesNo
If you answered YES to any of these, please explain further
I have used skincare products that caused an adverse reaction*

YesNo
If you answered yes to any of the above, please explain
Do you have any medical conditions that I need to be aware of? (this includes any historical conditions or surgeries.*
What medication are you on that I might need to know about? (all this information is kept confidentially) *
What supplements are you taking? *
Hormones

I need to ask some questions about hormones. All answers are kept confidentially.
Tick yes to any that apply:*

Still having periodsPeri-menopausalPost-menopausalCoil / implantEndometriosisSuperfluous HairHysterectomyHeavy PeriodsIrregular PeriodsThyroid IssuesPCOSNot ApplicableOther
Please explain further if you can
Great - time to delve a little deeper into your goals...
Have you had an Expert Skin Consultation before?*

YesNo
If yes, how did it help you?
Which of these statements is most applicable to you?*

I would like to look better for my ageI would like to change something that has been bothering me for a whileI would like to look after my skin betterOther
What are your main skin concerns?*
On a scale of 1-10, 1 being desperately unhappy and 10 being extremely happy, how satisfied are you with your skin?*
How does this make you feel emotionally, mentally and physically? What words would you use to describe yourself and how your skin impacts your work / social / relationships? (be as descriptive as possible)*
When did you first notice your concern(s)?*
Do you notice your skin concerns get better or worse at any time of the day/month/year/?*
What is your ultimate skin goal? Please describe how you would love your skin to look and feel after working with a Skin Expert. What does great skin look like for you? How would that make you feel?*
Are you ready to make a change?*

yesnoOther
How committed from 1 to 10 (10 being completely) are you to making that change? *
Are there any constraints I need to be aware of?*
Your Skin

These questions give me an overview of your skin's history and current factors affecting it.
Which of these do you believe you might have?*

Dry skinOily skinSensitive skinBlackheadsAcneSlack skin for your ageScarring (acne or injury)PigmentationNone of aboveEczemaPsoriasisDermatitisRosaceaOther
How was your skin as a teenager / young adult?
What is the ethnic background of your parents?*
Do you:*

Burn EasilyBurn then TanTan over timeTan EasilyOther
Please state your AM Routine: i.e. Foaming wash by ............. List all products in the order you use them and how you use them. Name brands and be as specific as possible please. *
Please state your PM Routine: i.e. Foaming wash by ......... List all products in the order you use them. *
DO you use any of the following to wash with? (you can tick multiple)*

flannelmuslin clothsplashhot waterlukewarm watercold water
Do you use any of these home devices?*

microcurrentLED MaskRadio FreqencyCleansing brushNone of above
How is your current skincare helping your skin concerns?*
What SPF do you wear, and how often?*
Are there any products you use that you forgot to mention? i.e. masks, scrubs etc?*
Lifestyle

This gives me a better idea of the factors that can influence your skin such as environment, stress and sleep.
What is your lifestyle? i.e. busy parent, spend a lot of time outdoors*
What is your occupation? i.e. office work, work outdoors etc
Do you smoke / vape?*
Do you get sick often? (i.e. tummy bugs/head colds etc) How often?
Stress*

I am chilled, low stressMy stress is mediumMy stress is highMy stress fluctuatesOther
What do you do to de-stress? i.e. meditation, get massages, read...
Sleep*

I sleep like a babyI sleep ok, but can be up and downMy sleep isn't greatI have insomniaI wake feeling refreshed most daysOther
Diet and Gut Health

This can massively impact the skin and the more you can tell me, the better my understanding can be of your skin.
Hydration*

I drink over 2l water a dayI drink 1-2l Water a dayI drink under 1l water a dayI drink more than 2 caffeinated drinks a dayI drink alcohol weekly (under 7 units a week)I drink alcohol (over 7 units a week)Other
Diet*

Has sweeteners (this includes diet soda drinks and chewing gum)Consumes dairy in diet (milk)Consumes dairy in diet (cream/ice-cream/cheese/yoghurt)VeganVegetarianFoods Intolerances(please state in other)Fair amount of sugar in dietLoads of fruit and vegPescaterianLow fat dietLow carb dietPaleo dietOther
Please list a typical daily diet, include snacks and as much detail as possible *
List any food allergies or intolerances
How is your gut health? (yes this is relevant, and confidential!)*

Regular as clockworkA bit bunged upA little looseAbsolutely shockingBloatingWindOther
How often do you "go"?
Now I would like to see your skin.

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Nearly there! Just a couple more questions.
How did you hear about me?*

RecommendationSearch engineSocial mediaOther
Preferred contact details

PhoneEmailAddressWhatsappText
Signature - I confirm I have answered accurately to the above.

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Appointment for Skin Guru Consultation™️ on Zoom (if you are seeing me face to face, just leave this)
Sam will contact you to arrange an appointment

Skin Guru Consultation Options

Online Skin Guru Consultation™️This is an online or in person skin consultation Please book your slot if you want a face to face Https://thebeautyguru.book.app

£49.00 Quantity

Skin Guru Consultation™️ and Treatment This includes your first Skin Guru Treatment™️

£99.00

Pre-paid Skin Guru Consultation™️ and TreatmentThis is if you have already booked in.

£ Free

Total

£0.00

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Personal Details

Medical Questions

Hormones

Your Skin

Lifestyle

Diet and Gut Health