Request Access to Face Reality Actives

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

5

What are your skin concerns?

6

What is your current AM Skincare Routine?* This field is required.

7

What is your current PM Skincare Routine?* This field is required.

8

Do you experience inflamed or cystic acne (painful, deep pimples)?

YESNO

9

Do you have any known allergies or sensitivities to skincare ingredients? * This field is required.N/A if you do not

10

How does your skin respond to active ingredients like benzoyl peroxide, salicylic acid, alpha/beta hydroxy acids, or retinoids?* This field is required.

11

Are you currently taking prescription skin medication like Accutane, Antibiotics, or Steroids?* This field is required.

Yes

No

Other

12

Are you using any prescription medications to treat your acne, or are you under the care of a dermatologist?Accutane, Antibiotics, or Steroids?

13

Are you (or will you be) pregnant or nursing?* This field is required.

Yes

No

14

Are you (or will you be) pregnant or nursing?

YESNO

15

Have you used Face Reality before? (Yes/No)* This field is required.

Yes

No

16

Upload a clear photo of at least 3 angles your skin * This field is required.

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