• Virtual Skincare Consultation Intake Form

    Thank you for booking your Virtual Skincare Consultation with J. Lanique Glam Studio! Before we meet, please take a few minutes to complete this intake form thoroughly. Your answers will help me understand your skin type, current routine, lifestyle factors, and skincare goals so I can create a personalized treatment plan tailored just for you. Please be as honest and detailed as possible. This allows me to recommend professional-grade products that truly support your skin’s needs. What You’ll Need: ・5–10 minutes to complete the form. ・Good lighting if you’re uploading photos ・ Information about the skincare products you currently use ・Any known skin sensitivities or allergies Why This Matters: ・Your skin is your largest organ and changes with age, stress, hormones, and routine. ・The more I know, the better I can support your skincare journey. ・My goal is to provide you with a custom plan and product recommendations that get real results. After completing this form, you’ll receive a confirmation email with your consultation details. Please be on time and ready for our video call with clean, makeup-free skin in natural lighting (if possible). Let’s get you glowing—inside and out!

  • 1.) Basic Info:

  • Format: (000) 000-0000.
  • Date of Birth
     - -
  • Preferred Contact Method

  • 2.)Skin History

  • Skin Type (Check all that apply)
  • How long have you had this skin type?
  • How does your skin typically react to new products?
  • Skin Concerns (Check all that apply)
  • Have you ever seen a dermatologist?
  • Have you ever had a professional facial or skin treatment?
  • Have you had any of the following treatments in the last 6 months?

  • 3.) Current Skincare Routine

    (List the products you currently use in each step. Leave blank if not applicable.)
  • How long have you been using your current routine?
  • Do you currently use any of the following actives? (Check all that apply)
  • How often of you exfoliate
  • How much time do you spend in the sun daily?
  • Do you use tanning beds?
  • Do you wear SPF Daily
  • Have you ever used professional-grade skincare before?
  • Have you ever has a reaction to skincare products?

  • 8.) Medical History

  • Are you currently pregnant or nursing?
  • Do you have any allergies? (ingredients, medications, etc.)?
  • Are you currently taking any medications that may affect your skin? (Check all that apply)

  • 9.) Lifestyle Factors

    (These help you assess skin from the inside out.)
  • Water Intake daily:
  • Diet:
  • Stress Level:
  • Sleep Schedule:
  • Hormonal Changes:

  • 10.) Skin Goals

    What are your top 3 skin goals right now? Think beyond just appearance — include how you want your skin to feel, how much time you want to spend on your routine, and any events or milestones you're preparing for (like a wedding, vacation, or birthday).
  • What is your timeline for seeing results?

  • 11.) Preferred Product Range

    Please select the type of skincare products you’d like included in your plan. You can change this later after we review your skin needs together.
  • What is your current skincare budget (per month)?
  • Are there any ingredients you prefer to avoid?

  • 12.)Upload Photos

    Front, Left, and Right Profile (in good lighting and no makeup) 📷 Photo Tips for Best Results Clear, well-lit photos help me give you the most accurate skin analysis possible. Here's how to get the best lighting: ✅ Best Lighting Options: Natural daylight — Stand near a window with the light facing you (not behind you). Overcast days actually work great — the light is soft and even. Ring light — If you have one, use it! Face it directly toward you for shadow-free, even lighting. Well-lit room — Stand under a bright overhead light or between two lamps. Make sure the light is in front of your face, not to the side. Outdoor shade — Step outside in a shaded area (not direct sun) for natural, flattering light. ❌ Avoid: Bathroom lighting (it casts shadows and distorts skin tone) Backlit photos (window or light behind you) Dark or dim rooms Heavy filters or beauty mode on your phone camera 📱 Quick Tip: Use your phone's portrait mode turned OFF — you want a clear, unfiltered image so your skin is visible as-is.
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  • 13.) Preferred Video Chat Platform

    Please select the video chat platform you’d like to use for your virtual skincare consultation. A secure link will be sent to you based on your choice prior to your scheduled appointment.
  • What platform do you prefer

  • Virtual Skincare Packages

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          Package 1: Virtual Glow Consultation

          Perfect if you want expert skincare advice and a fully customized plan using professional-grade products. This package is service-only — products are purchased separately so you can build your perfect routine. Includes: • 30–45 minute virtual consultation • Personalized AM & PM skincare routine • Professional product recommendations with clickable links to purchase • 14-day follow-up support via email or DM Products not included — you’ll receive your recommendations with easy links to order directly.

          $60.00$60.00
            
          Package 2: Glow Start Kit + Virtual Consultation — $130 (Products Included)

          Jumpstart your skincare journey with expert guidance and a starter product bundle shipped to your door. Includes: • 30–45 minute virtual consultation • Personalized AM & PM skincare routine • Customized Starter Kit (3–4 professional products tailored to your skin type) • Product shipping & delivery included • 14-day follow-up support via email or DM Value: Products + expert guidance = $180+ value for just $130.

          $130.00$130.00
            
          VIP Glow-Up Package

          VIP Glow-Up Experience — $200 (Full Transformation Kit Included) For clients ready for a complete skincare transformation. This package includes a premium product bundle, ongoing support, and exclusive perks. Includes: • Everything in the Glow Start Kit package • 30-day follow-up check-in (video or phone) • Up to 5 full-size professional products tailored to your skin type & goals • Priority access to future product launches + exclusive discounts • Skincare tracker sheet + digital glow-up guide Value: Products + expert guidance + follow-up care = $300+ value for just $200.

          $200.00$200.00
            
          Total
          $0.00$0.00

          Payment Methods

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          After submitting the form, you will be redirected to Google Pay to complete the payment.
        • Please select the day(s) that work best for your virtual skincare consultation. This helps me match your availability with mine so we can schedule a time that works for both of us.All consultations are done via video call (Zoom, FaceTime, or Google Meet) and last about 30–45 minutes. You’ll receive a confirmation message once your appointment is scheduled.Let me know if you’re flexible or have specific time preferences in the additional notes section at the end of this form.

        • 14.)Additional Notes

          (Is there anything else you’d like me to know before your consultation?)

        • 15.)Terms & Conditions

          By booking a Virtual Skincare Consultation with J. Lanique Glam Studio, you acknowledge and agree to the following: ・Consultation Purpose:This virtual consultation is intended to provide professional skincare advice and product recommendations based on the information you provide. It is not a substitute for medical advice, diagnosis, or treatment from a licensed healthcare provider or dermatologist. ・Accuracy of Information:You agree to provide honest and accurate information on your skin type, concerns, and medical history. Recommendations are made based on your responses and visible skin analysis during the consultation. ・Results Disclosure: Skincare results vary by individual. No specific outcome can be guaranteed. Consistency, proper use of recommended products, and lifestyle habits play a significant role in skin health. ・Product Purchases: Products recommended may be available for purchase via Skin Script, Pomp, or other professional suppliers. Product purchases are optional but highly encouraged for best results. ・Privacy:All personal and skincare information collected is confidential and used solely for the purpose of your consultation and follow-up.

        • 16.)Cancellation & Rescheduling Policy

          ・Cancellations must be made at least 24 hours in advance of your scheduled consultation time. ・If you cancel with less than 24 hours’ notice or do not show up for your appointment, the consultation fee is non-refundable and cannot be transferred. ・You may reschedule one time with at least 12 hours’ notice, subject to availability. ・Consultation fees are non-refundable, but if you proceed with product purchases during your consultation, a portion of your consultation fee may be applied as product credit (if applicable at the time of booking

        • 17.)Consent

        • Date*
           - -
        • Should be Empty: