George Street Hair & Nail Salon

The George Street Hair and Nail Salon

Skin Consultation
When filling in this consultation please complete all sections to help give us the information we need to make your produts with the best ingredients to suit you.
Name*

First NameLast Name
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number

area code Phone number
Mobile

country code mobile number
Date of Birth*

MonthDayYear
Date
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What changes are you hoping to see in your skin ?*
What skin care range do you normally use?*
When you first wake before applying moisturiser does your skin feel tight?*
Do you have clogged pores (Blackheads or whiteheads)*
Do you have fine lines or wrinkles?*
Do you have acne or spots?*
Does your face get red after moderate exercise or stress?*
After a spot or cut do you develop a dark brown or black spot?*
Do you suffer with pigmentation (Freckles or brown spots, (sometimes referred incorrectly as age spots)?*
Do you have enlarged pores?
Have you engaged in tanning for more than 2 weeks per year?*
When you are exposed to the sun do you?*
Do you wear SPF or Sunscreen?
Do skin care products cause you to itch, break out or sting?*
Are you pregnant or breast feeding?
Are you taking any prescription medications?*
If yes , which ones?*
Is there any medical History that has affected your skin?
Do you have any allergies to Skin care ingredients, essential oils, or any particular skin care make? *
If yes please specify which ones
Aromas you prefer*

FloralMintMuskySpiceySweetWoodsy
What consistency do you prefer for your facial cream

ThickMediumRunny
Do you require Vegan Ingredients*

YesNo
Can we have a selfie?

Sure
Any area of worry for you if we cannot have a face to face consultation Cancelof
What Organic skin care products are you looking For?*

CleanserExfoliatorMoisturiserSerumBeard oilAfter shaveBody butterBody oilBody lotionBody scrubEmbrace the Elements RangeBaby RangeOther
Would you like to join our mailing list

Yes PleaseNo Thank you
I confirm that the information I have given is correct to the best of my knowledge*

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The George Street Hair and Nail Salon

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