Skincare Consultation Form
Please fill out this form to help me understand your skin type and concerns for personalized skincare recommendations.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Facebook Profile Name (so I can find you!)
*
Instagram Handle Name (so I can find you!)
*
@examplename
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
PART 1
SKINCARE QUIZ
How would you describe your skin most days?
*
Please Select
Oily & Shiny
Dry & Flakey
Combination (oily T-zone & dry cheeks)
Sensitive & reactive
Normal & Pretty Chill
Acne prone (breakouts & clogged pores)
Choose choice above from dropdown that best describes your skin
What are your top 3 skin struggles that you are currently experiencing?
Oiliness, Acne, & breakouts that won’t quit
Dryness/tight or flaky skin
Redness/Inflammation
Sensitivity burning or irritation from products
Dark Spots or Scarring
Uneven Skin Tone or Texture
Wrinkles or fine lines
Dullness no GLOW!
Have you ever had a bad reaction to a skincare product?
Yes, my skin burned and broke out badly
I think so, don’t know if it was purging or reacting
Nope, I can usually use anything
How simple or extra do you want your routine to be?
So simple! I barely have time to wash my face
Give me 3-4 steps max!
I LOVE a full routine, bring it on!
Are you using any of these right now?
Retinol or Alternative Retinol (bakouchial)
Exfoliating Toner (glycolic or salicylic)
Vitamin C Serum
Acne medications (benzoyl peroxide, tretinoin, other prescription)
None, or not sure!
How would you like your skin to feel in the next 30 days? (Example: calm, glowy, clear, less painful, confident again)
Do you wash your face in the morning?
Yes
No
Do you double cleanse at night?
Yes
No
What’s that?
Please describe your current skincare routine and products you are using.
PART 2
Optional Makeup Quiz (GLOW UP IN 5 minutes or less!)
Want recs for an everyday 5-minute face? Just a few more questions…
What makeup do you wear on most days?
Just mascara and brow gel
Foundation or tinted moisturizer
A little blush or bronzer
Lip balm
Lipgloss/Lipstick
I rarely wear makeup
What’s your vibe when it comes to makeup?
Keep it natural, I don’t want to look overdone
Just enhance what I already have
I love a clean radiant glow
If it’s fast and easy I’m in!
What’s your biggest struggle with makeup?(Example: hard to match foundation, feels cakey, don’t know what looks good on me)
For the perfect match for foundation for you Please upload a clear selfie in natural lighting, here’s how to get the best results:✔️. ✔️Face a window during daylight ✔️No makeup or filters ✔️Hair pulled back if possible. ✔️Show your full face, neck, and top of your chest (This helps me see your undertone + natural skin tone so I can recommend your closest shade match!) Upload your photo below ⬇️
Browse Files
Drag and drop files here
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Anything you’d love help picking?
My perfect everyday mascara
My shade in foundation
Bronzer/blush combo that flatters
Full 5-minute makeup routine
Not sure yet!
Submit
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