Virtual Consultation Form
Thank you for choosing Angelina Esthetics! I can't wait to connect with you and help assist you to achieve your overall skin care goals & results. I can confidently stand behind to give you the skin of your dreams!
Are you ready to transform your skin? ✨
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Please Select
Yes! Let’s get into details
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Please introduce yourself
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First Name
Last Name
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
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Please select 1-2 time slots for a 20-30 minutes virtual consultation. If in person is requested please check box + time slot.
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Monday 9am-1pm
Thursday 9am-7:30pm
Friday 9am-7:30pm
Sunday (varies)
Saturday (varies)
Prefer in Person
Other
Virtual Consultation Fee:
$50 Virtual consultation fee. Within 72 hours an invoice is sent to email provided. Once invoice is paid a consultation will be scheduled around time selected.
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I'm Ready!
I'm Ready!
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Do you have any of the following?:
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Fine Lines or Wrinkles
Comedones/Black Heads
Pustules/White Heads
Cystic Acne
Hormonal Breakouts
Occasional Breakouts
Dark Pigmentation - Hyperpigmentation
Light Pigmentation - Hypopigmentation
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Please upload a picture of all your skincare you are currently using:
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Browse Files
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Some ingredients need to be avoided when trying to conceive, pregnant or nursing. Please answer honestly.
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Pregnant
Trying to conceive
Nursing
NA
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Select from the following:
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My budget is strict, give me only the essentials.
My budget is flexible, but I want to start slowing with professional products.
I'm ready to start my full new skin care routine.
I'm ready to start my full new skin care routine and treatments.
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Do you have any sensitivities or allergies to any products or ingredients?
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Yes
No
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If yes, Please explain further:
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Please select your main skin concerns:
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Acne
Acne Scarring
Sensitive Skin Redness
Hyperpigmentation (Dark Spots)
Uneven Skin Tone
Oily Skin
Dry Skin
Texture/Congested Skin
Blackheads
Whiteheads
Tell us about your skin. Starting with what you will like to improve, skin history, acne concerns or scarring, please feel free to include any information you feel that will be helpful with your skin care consultations and facial treatment plan.
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How would you best describe your skin type?
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Oily (Breakouts, Blackheads, Shine appearance.)
Dry (Skin feels tight & commonly flakey.)
Normal (Balanced & Smooth.)
Combination (Dryness but oily in t-zone.)
Very Sensitive
Not Sensitive
Is there anything else you'd like me to know about you or your skin?
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Please upload clear, good quality photos of your clean skin in natural light, capturing three angles: left, center, and right. Hold each position for a few seconds with your eyes closed. These photos/videos will help track your progress throughout your skin care journey.
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Browse Files
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Choose a file
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How did you hear about Angelina Esthetics? Social medial, referral(Please provide name of who referred you), google etc
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A personalized 1-on-1 video consultation to assess your skin concerns, current routine, and goals. You’ll receive expert guidance from Angelina Esthetics a Licensed Esthetician and acne expert, customized product recommendations, and a treatment plan tailored to your skin all from the comfort of your home. You will also receive full access to multiple medical skin care products from my website. A complimentary email followup is scheduled 4 weeks after new routine is purchased. Can’t wait to meet you soon! Signature
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