Online Skin Guidance

ONLINE SKIN GUIDANCE

Congratulations! You're on your way to vibrant, healthy skin with a professionally curated skin regimen by a certified skin therapist. This professional recommendation will include 4-6 products to start targeting your skin concerns and support a transformative change within your skin. I will assess your skin history and current skin condition so I can create the best plan for you possible. Your new homecare products will come with instructions for starting your new skin care routine.
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about White Feather Skin Therapy?*

InstagramFacebookGoogle SearchFamily or FriendOther
How would you describe your skin?*

Dry (Small pores all over, never oily and drinks in moisturizing products)My skin feels normal and balancedOily (Large pores on nose and cheeks and stays oily throughout the entire day)
Please choose your current skin concern you'd like to address:*

Sensitive/RednessBrown Spots or PatchesAging concerns like fine lines or wrinklesExcessive oilinessLarge PoresOther
What are your skin goals?*

Prevent wrinklesHealthy, vibrant skinEven complexionSmooth TextureOther
Have you been prescribed topical medications at all the past 6 months? Please list them all or write N/A if none.*
Are you currently under the care of a dermatologist?*
Please list all allergies.*
Tell me a little bit about your skin story: How do you feel about your skin currently, what products or treatments have you tried in the past, why do you want healthy skin, what you would like it to be, etc.*
Please understand when addressing corrective concerns, you WILL need more than 2-3 products. However, you can always start with a minimal regimen and build as you go. (Choosing this route will require patience to see results until you can commit to a full regimen.) IF you are only looking for the basics and not looking for a full regimen, please say so here.*
Do you tend to always try new products or do you give your skin 3-6 months before determining if they are effective?*
Do you wear makeup?*

Yes but I always wash it off before bedYes and I sometimes go to bed without washing it offNoOnly for special occasions like a wedding or family photos
Do you have a current skincare regimen?*

YesNo
If you answered yes to the question above, what does your routine currently consist of? Please check all that apply. Please check N/A if this does not apply to you.*

CleanserTonerEye CreamMoisturizer without SPFSunscreenFacial OilExfoliant like a scrub or enzymeRetinolN/A
Please list the names/brands of the products you are currently using below. Be very specific here so I can reference what you are currently using and make an appropriate recommendation. I will be researching each of these products. If you feel any of these products has made a difference in your skin please indicate which one and explain. Please enter N/A if you do not have a current skincare regimin.*
When your skin is exposed to the sun do you....?*

Always burnNever BurnOccasionally burn
What is your ethnicity?*
Are you pregnant, nursing or trying to conceive?*
Please attach a photo of your skin WITHOUT makeup (in daylight is best). This helps immensely to evaluate your skin. You can include only parts of your face and not show your whole face if that is more comfortable for you.*

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Is there anything else you would like for me to know or do you have any questions for me?
Thank you for your interest in White Feather Skin Therapy, I look forward to connecting with you.

I respond by email as soon as I can during business hours. Please check your spam folder if you have not heard back within two business days.
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