Home Care Regimen Form

Home Care Regimen

AlumierMD Medical Grade Skincare Products
Date

MonthDayYear
Date
Name

First NameLast Name
Email Address
example@example.com
Cell Number
Or best number to reach you.
Please select from the following products you are currently using for your skincare routine indicating "how often" and "when" you are using each item:
CLEANSERS

Purifying Gel.....AMPMHydraBoost.......AMPMAcne Clarifying.AMPMSensiCalm.........AMPMOther, please list
EXFOLIANTS

Bright&Clear SolutionAMPM1-2/weekLotus Scrub................AMPM1-2/weekEnzymatic Peel...........AMPM1/weekAHA Renewal Serum..PMEvery Other PMOther, please list
SPECIALTY SERUMS

EverActive"C&E"+Peptide.....AMVitamin Rich Smoother "C"...AMRetinol .25%................PMAlternate nightsRetinol .5%..................PMAlternate nightsRetinol 1%....................PMAlternate nightsAlumience A.G.E..............AMPMUltimate Boost Serum.....AMPMCalmR...............................AMPMEvenTone Brightening.....AMPMIntellibright.......................AMPMLightening Lotion.............AMPMAcne Balancing Solution.AMPMMatticlear.........................AMPMSpot Clearing Lotion.......AMPMOther, please list
EYE PRODUCTS

AluminEye Cream.......AMPMRetinol Eye Gel..........................PMEye Rescue Gel Pads..AMPM1/weekOther, please list
MOISTURIZERS

HydraSmooth......AMPMHydraClarité........AMPMHydraLight..........AMPMHydraDew...........AMPMHydraRich...........AMPMHydraCalm..........AMPMRecovery Balm....AMPMNeck & Décolleté Firming CreamAMPMOther, please list
SUNSCREENS

Moisture Matt SPF40 (IVORY)............AMMoisture Matt SPF40 (SAND).............AMMoisture Matt SPF40 (AMBER)...........AMSheer Hydration SPF40 (Untinted).....AMSheer Hydration SPF40 (Tinted).........AMClear Shield SPF42...............................AMOther, please list
TOPICAL MEDICATION OVER COUNTER OR DOCTOR PRESCRIBED

NoneOther, please list AND advise; purpose & daily usage
IN-CLINIC PROFESSIONAL TREATMENTS
Please select treatments you would like to book

Medical PeelIPL Photo Facial for HyperpigmentIPL Photo Facial for RosaceaIPL Photo Facial for AcneIPL Photo Facial for Anti-AgingBlemish Removal (Electrocoagulation)
Should be Empty:

Home Care Regimen

Please select from the following products you are currently using for your skincare routine indicating "how often" and "when" you are using each item:

IN-CLINIC PROFESSIONAL TREATMENTS