SKINCARE CONSULTATION
What is your name?
What is your age range?
18-25
26-39
40-55
56+
How would you describe your skin type?
Oily; skin is shiny and pores are visible
Normal; skin feels neither dry nor oily
Combination; skin is oily in some areas and dry in others
Dry; skin feels dry and tight
Sensitive; skin is delicate, rosacea, psoriasis etc.
What is your main skin concern?
Dullness/lack of radiance
Fine lines and wrinkles
Dehydration
Texture
Large pores
Uneven skintone
What is your main skin goal?
Bright, radiant skin
Clear, even skintone
Hydrated skin
Reduce fine lines and wrinkles
Do you exfoliate
No, but I should
Yes
No, never
Are you prone to dark circles and under eye bags?
Yes
Nope
Email
Phone
Do you prefer
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Email
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