Form
FACE REALITY
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Please answer ALL questions to be able to perform the best facial for your skin! Thank you see you soon!
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
please add your age here:
Which best describes your skin tone?
Very fair, always burns, never tans
Fair, usually burns, sometimes tans
Medium, sometimes burns, usually tans
Olive / light brown, rarely burns
Brown, very rarely burns
Deep brown / dark, never burns
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Which best describes your skin most days?
dry
normal (oily and dry)
oily
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Do you currently experience breakouts?
Mostly clogged pores / blackheads / whiteheads
Red or inflamed breakouts
Mild / Moderate / Severe
Not really
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Do you consider your skin sensitive?
yes
no
Type option 3
Type option 4
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Have you ever used benzoyl peroxide before? yes or no
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Are you currently:
Pregnant
Nursing
neither
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What would you most like to improve with your skin right now?
acne
hyperpigmentation/dark spots
anti-aging fine lines
hydration/glow
redness
rosacea
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Do you have any known allergies or ingredients your skin reacts to?
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Should be Empty: