Welcome
You are on your way to healthier skin. Let's glow!
Please fill out all information below so I can contact you with your personal skincare regimen recommendations
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
What is your best contact method? (Text/Call/Email)
Do you have a skin care routine?
If yes, what does it consist of?
Cleanser
Toner
Moisturizer
Serum
Eye cream
exfoliant
Other
Are you interested in helping your friends and family with their skin and earning extra income by partnering with Pomifera and joining my team?
Yes, please!
I would like more information
Maybe in the future
I want to try the products first!
No, I just want to be a loyal customer
Is your skin…
Dry
Oily
Combination
Sensitive
Other
How does your skin feel a few hours after wearing moisturizer?
Dry
Oily
Dry patches & oily patches
I dont use moisturizer
Do you have... (select all that apply)
Sun damage
Age spots
Discoloration in skin tone
Rosacea
Eczema (face/body)
Sensitivity
Do you struggle with acne?
Yes
No
Do you have stretch marks?
Yes
No
Do you have large pores?
Yes
No
Do you have... (select all that apply)
Puffiness under eyes
Dark circles
Do you have... (select all that apply)
Fines lines
Deep wrinkles
How often do you wear makeup?
Daily
Once in while
Never
Do you have skin related allergies? If Yes, please list below…
To make sure I recommend a regimen that you are 100% satisfied with, what is your budget?
$50-$85
$85-$120
$120 & up
I would just like a recommendation
Questions or comments?
Thank You
for trusting me to help you find the best skincare for YOU! You are one click away from having the skin you deserve!
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