Form

Face Yoga for Mature Skin

Conusltation Form
Name*

First NameLast Name
Age*
Today's Date

MonthDayYear
Date
Please mark any that apply*

I'm pregnantI have a disease that affects my lymph nodesI have physical pain in my faceI have skin conditions such as acneI have a neck or shoulder injuryNoneOther
Our lifestyles can affect our faces. The following questions will help me to determine your needs more efficiently.
How much sleep do you get a night?*
Do you suffer from frequent headaches?*
Do you have neck or shoulder pain?*
What are you looking to achieve with face yoga?*
Do you have any particular concerns such as hooded eyes, etc? Please explain below.*
Have you tried face yoga before? If so, please explain your experience.*
Thank you for taking the time to fill out this consultation form.

Please submit 3 pictures of your face: full frontal, then one from each side. Send it to kelli@faceyogaformatureskin.com

Once I have this completed form and your pictures, I will work on a facial profile for you with face yoga recommendations. Please allow at least 3 days to complete.

I look forward to helping you reach your goals!

Kelli
Did you send your three face pictures to kelli@faceyogaformatureskin.com?
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Face Yoga for Mature Skin