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.Format: (000) 000-0000.
Please select from the following products you are currently using for your skincare routine indicating "how often" and "when" you are using each item:
Purifying Gel.....AMPMHydraBoost.......AMPMAcne Clarifying.AMPMSensiCalm.........AMPMOther, please list
Bright&Clear SolutionAMPM1-2/weekLotus Scrub................AMPM1-2/weekEnzymatic Peel...........AMPM1/weekAHA Renewal Serum..PMEvery Other PMOther, please list
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
AluminEye Cream.......AMPMRetinol Eye Gel..........................PMEye Rescue Gel Pads..AMPM1/weekOther, please list
HydraSmooth......AMPMHydraClarité........AMPMHydraLight..........AMPMHydraDew...........AMPMHydraRich...........AMPMHydraCalm..........AMPMRecovery Balm....AMPMNeck & Décolleté Firming CreamAMPMOther, please list
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
NoneOther, please list AND advise; purpose & daily usage
IN-CLINIC PROFESSIONAL TREATMENTS
Medical PeelIPL Photo Facial for HyperpigmentIPL Photo Facial for RosaceaIPL Photo Facial for AcneIPL Photo Facial for Anti-AgingBlemish Removal (Electrocoagulation)
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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