ECLAT SKIN QUIZ

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Welcome to ÉCLAT! Let’s get to know each other — what’s your name?* This field is required.
First Name
Last Name
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Nice to meet you! Let’s dive in — just a few quick questions to help us understand your skin, goals, and preferences.* This field is required.
I'm in my teens
I'm in my 20's
I'm in my 30's
I'm in my 40's
I'm in my 50's
I'm 60+
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Using the images below, which skin tone best matches yours?
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Based on the photos above, which skin tone best matches yours?* This field is required.Choose One
Choice 1 - Pale, White
Choice 2 - White, Fair
Choice 3 - Medium White to Olive
Choice 4 - Olive Tone
Choice 5 - Light Brown
Choice 6 - Dark Brown or Black
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Give Us the Tea! Have you tried any medical esthetics or undergone plastic surgery procedures? Your answer helps us better understand your skin history so we can tailor your recommendations more effectively.* This field is required.
No, I'm a Newbie
Yes, I've dabbled with injectables and lasers
Yes, I've had some subtle surgical tweaks
Girl, I've done it all !
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Which areas of your body, skin, or wellness would you like to feel more confident about?* This field is required.Choose all that apply
ACNE CONTROL
SAGGING / AGING
SUN DAMAGE / SPOTS
TEXTURE / SCARRING
REDNESS / ROSACEA
LINES/ WRINKLES
DRY/ DULL SKIN
CELLULITE/TONE
POST SURGICAL SCARRING
UNWANTED FAT
BODY / JOINT PAIN
HAIR LOSS
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Is there anything else you’d like us to know about you or your selfcare journey?* This field is required.
I have a special event coming up and want better skin / body confidence
I am planning on having a surgical procedure and need pre/post recommendations
I'm seeking a natural approach to aging (without injectables)
I am interested in holistic wellness and pain management
I have strong allergies which prohibit me from using certain products
I need help planning my skincare and treatment regimen so I don't waste money
8
What's your #1 favorite skin care product?
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Provide your general health to help us choose the safest treatments for you* This field is required.
Auto Immune / Diabetes
Heart Problems / Pacemaker
Pregnant / Nursing
PCOS or Hormone Imbalance
Accutane / Chemotherapy
Recent Weight Loss / GLP1's
Allergic to Steel / Nickel
N/A None
Blood Clotting Disorder
Cancer/ Radiation
Recent Accident or Injury
N/A - None
10
Are you on any antibiotics or medications? * This field is required.
YESNO
11
What is your Cosmetic History?
Facial Surgery
Facial Laser Treatment
Botox or Filler
Accutane Usage
Chemical Peels
Acne Prescriptions / Retinol
Sensitive to Lidocaine
N/A
12
How often do you feel you need facials?
Monthly
Quarterly
Couple times a year
Only before an event
I've never had a facial
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Ready to Begin Your Wellness Transformation?* This field is required.
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What benefits are most important to you?
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Our facials are priced from $55 to $400. Use the slider to indicate your budget for treatment:
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OPTIONAL: You're unique and so is your skin! For more personalization, please provide us with a photo of your face, showing your main concerns.
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Have we left anything out? Share any additional details about important health issues, events or needs.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Please let us know how you heard about us!
Google
Facebook
Instagram
Yelp
Referral
Other
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Were you a referral? Please mention the name of the person who referred you:
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Please note without the benefit of a thorough, in person consultation we cannot definitely offer all treatments. The information presented is for educational purposes and does not constitute medical advice. Please provide an email to receive your
Clear
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Need help booking a facial or consult? Drop your phone number below, and we’ll reach out to make scheduling easy.
Please enter a valid phone number.
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You're almost done! Please note - this quiz is designed to offer general insight into our services and help identify your skincare and wellness concerns — it does not provide medical advice. Once you've entered your email below, be sure to click submit so our esthetician can review your responses and follow up with personalized recommendations for you.* This field is required.
example@example.com
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