Posh. Skincare Solutions
Please fill these in to the best of your ability so that we can create your personalized skincare routine.
Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
1. What is your age range?
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Teens
20's
30's
40's
50's
60's
70's
80's
90's
2. Which describes you best, hormonally?
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Prepuberty
Puberty
Teen
Pregnant
Nursing
Adult
Perimenopausal
Menopausal
Post Menopausal
Using oral contraceptives
Coming off of Oral contraceptives
3. What are your biggest concerns about your skin?
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Acne
Pores
Aging
Dark spots
Dullness
Wrinkles
Dark circles
Redness
Sensitivities
Generally happy with skin, just would like a solid routine
Looking for a new routine, feels like time
I want to be proactive with new blemishes
I want to be proactive with new signs of aging
Other
4. What type of skin do feel you have? Most often our skin can present many ways and might only be a bit confused, not a 'set in stone' type
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Oily
Dry
Combination
Balanced
No idea
Changes with Seasons
Confused
Stressed
Sensitized
Sensitive
5. How much make up do you use per day?
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None
A little
A decent amount
Full coverage
6. How often do you feel that your skin is sensitive?
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Never
Rarely
Sometimes
Always
7. Do you feel stressed about how you look and feel?
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Yes
No
8. Do you have many stressors in life? Think job, family, environment, pressures, too many meetings, kids activities, health of loved one. These are all normal, but we need a full picture when planning the correct skincare.
9. If you have acne, are you a picker? Many of us are, don't worry.
10. Do you have any known allergies to skincare or food ingredients? If so, what are they?
11. Are you afraid of or leery of using any skincare products or ingredients?
12. How much time do you spend in front of electronic devices per day?
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Less than 1 hour
1-3 hours
3-6 hours
6-10 hours
More than 10 hours
13. Do you experience any of the following medical conditions? Please answer all that apply, these conditions all affect the skin greatly.
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Asthma
Eczema
Allergies
Rosacea
Acne
Digestion Issues
Anxiety
Depression
Other
14. What type of weather do you experience where you live?
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Saskatchewan
City dweller, inside a lot
Cold winters & mild summers
Dry & hot desert
Cold & dry year-round
Tropical
British Columbia
Rural Life, outside a lot
Varies greatly each season
Other
15. Have you recently moved from a hot, humid climate to a dry climate? If so, did you notice a change in your skin?
16. How much time do you spend to take care of your skin per day?
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Less than a minute
A few minutes
Around 5 minutes
More than 7 minutes
17. How much time do you want think is reasonable for you to consistently spend on your skin each day?
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Less than a minute
A few minutes
Around 5 minutes
More than 7 minutes
18. Do you care for your face multiple times each day on average?
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Morning only
Evening only
Morning and Evening
I don't currently care for my skin
I try but find I skip a lot in the evening
I try but find I skip a lot in the morning
Morning, after training or workout, evening
19. What type of cleanser you you use to wash your face?
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Just water
Water and a foaming cleanser
Water and an oil based cleanser
Other
20. How do you wash your face?
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In the shower
In the tub
At the sink
I don't wash my face
In hot water
Lukewarm water
Other
21. How often do you wash your face each day?
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Just morning
Morning and Evening
Just evening
I don't wash my face
Other
22. Do you currently use a toner?
23. Do you currently use serums?
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Never
Sometimes
Most Days
Twice each day
24. Do you currently use moisturizers?
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Never
Sometimes
Most Days
Twice each day
25. Do you currently use facial oils?
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Never
Sometimes
Most Days
Twice each day
26. Do you currently use Sun Protection?
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Never
Sometimes
Most Days
Just in the summer
Just when I think I'll need it
27. Do you use exfoliators? If so, what do you like? There are physical scrubs or chemical exfoliators such as lactic acid.
28. If so, how often do you use them?
29. Do you do at home mask treatments? If so, what do you like?
30. Do you do at home facial massage? If so, what and how do you do it?
31. Are you or have you ever been on Accutane or other similar medication?
32. If so, are you currently using it? When did you stop taking it?
33. Do you currently use any acids such as Retinoids, Tretinoin, Glycolic, Salicylic, Lactic Acid or other actives? Which ones?
34. If so, how long have you been using them? How often?
What is your current routine? Please include the product and brand.
Please include image of any skin concern, such as breakouts or rashes. All images are confidential.
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