Glow by Sabrina's Acne Skin Care Questionnaire

Please do not fill this form out unless you are serious about purchasing skincare products and want to achieve heathy, glowing skin!
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Let me know who referred you so I can thank them!
Tell me a little about your current skin care routine:*
What is your age range?*

Teens20s30s40s50s60s+
Select the ONE statement that best describes your current skin care needs:*

I have sensitive skin that gets irritated easily. I also struggle with acne prone skin.I have mild-to-moderate acne blemishes I would like to address.I have severe acne blemishes that need to be treated.Other
Select the ONE statement that most closely describes your skin care type:*

Combination (T-Zone)NormalOilyI'm not sure?
Tell me your skin concerns:*

Mild acne breakoutsBlack heads / Large poresSevere acne breakouts- deeper cystic bumpsDehydrated skinHormonal breakoutsSensitive skin (redness, burning)Oily skinDull skin / lack of clarityScarring from acne blemishesFine or expression linesOther
Any allergies to Salicylic acid, Glycolic acid Mandelic acid (almonds), or Benzoyl Peroxide?Any allergies or reactions to any ingredients?*

YesI'm not sureNoOther
Are you on any kind of prescription medications to treat acne? Or are you using tretinoin-prescription retinol?*
Are you currently taking birth control? If so, which one?*
Please take a photo of your skin in good lighting for me to analyze. These will never be shared.*
Is there anything else you need to add or want to let me know about?*
Skincare Product Recommendations-

I will put together a Face Reality skincare routine based on the answers above. The pricing varies depending on what is needed. A full skincare routine is typically around $200+. The products usually last 4-6 months. A little goes a long way. Keep that in mind when budgeting.

I will email a routine, along with instructions, and payment link to the number provided.

I will educate you on how your diet, gut health and lifestyle all affect your skin. I will explain how acne-prone skin needs the proper exfoliation and hydration to clear and heal. Face Reality uses active ingredients such as Mandelic, Salicylic, Glycolic, & Benzoyl Peroxide to treat different acne types.

Face Reality is a professional product line that uses the most effective ingredients at an affordable price point.
Skincare Product Haul! Let me know if you want to purchase a full routine or need to start with the basics!*
I would like to schedule a virtual consultation. *There will be a 35$ fee for the consultation.*
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