Clone of SKIN CONSULTATION FORM

1

Name

First Name

Last Name

2

What is your main Skin concern/s?

eg: Acne, Dryness,

5

Do you use SPF?

Yes

No

Sometimes

Daily

6

How often do you cleanse your face?

Once daily

Twice daily

Every other day

Whenever I remeber

7

What do you use in your current routine? (If you have one)

8

Is there anything else we should know about your skin health or history?

9

How much would you like to spend?

$150-$250

$250-$300

$300-$400

Other

10

Would you like to join as a VIP with a one-time fee?Prices differ depending upon country

No, I'll pay full retail

Yes Ill pay the one off $32.99NZD. (Gives access to flash sales, Your own website, A Free only for you product + more

11

What Country do you live in?

12

Email

example@example.com

13

How would you like to be contacted?

Facebook

Instagram

Text

14

Please provide handle name

Instagram:Kairo_Oriak22

15

Signature

16

Thank you for taking the time to fill out my Skincare Quiz 🥰

I will contact you shortly with a customised cart that best suits you and your skin :) xo