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Let’s Curate Your Personalized Skincare Routine
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Name
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First Name
Last Name
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Email
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example@example.com
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Skin Types
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1 .How would you best describe your skin type based on the previous chart?
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2. What is your age range?
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3. How would you describe your skin? Select all that apply
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Dry
Oily or Acne-prone
Combination
Sensitive
Normal Skin
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4. What areas of concern do you have regarding your skin today? Select all that apply.
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Breakouts/Acne(I highly recommend a virtual consultation for best results.)
Excessive Oil/Shine
Broken Capillaries
Blackheads/Whiteheads
Wrinkles/Fine Lines
Redness/Ruddiness
Uneven Skin Tone
Dull Dry Skin
Dehydrated
Sun Damage
Rosacea
Sun/Liver/Brown Spots
Eczema
Milia
Acne Scars
Patchy Dryness
Melasma (If this is your main concern, I highly recommend scheduling a virtual consult instead.)
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5. Have you ever had an allergic reaction to any of the following?
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Cosmetics
Food
AHA/BHA
Hydroquinone
Fragrance
Sunscreen
Latex
Not Applicable
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6. Please describe any allergic reactions here:
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7. Is there anything else you would like to add regarding your skin before we curate your skin regimen?
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YES
NO
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If so, please list it here:
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8. Do you need me to stay within a certain budget?
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9. What type of routine are you willing to commit to?
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Bare minimum: Cleanser, Moisturizer, SPF
Simple Regimen: Cleanser, 1-2 Corrective Serums, Moisturizer, SPF
Full Routine. Give me everything I need.
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10. Are you comfortable using products containing human derived growth-factors?
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Yes
No
Maybe, please tell me a little bit more about this.
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15
Please upload a clear picture of your skin freshly washed, with no makeup using your back camera in natural daytime lighting. Take 3 pictures, front angle and one on each side.
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