Skin Reset

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.So I can WhatsApp your recommendations

Area Code

Phone Number

4

Are you* This field is required.

A new client

An existing client

5

What concerns you most about your skin right now?* This field is required.

My skin looks tired

Rough or uneven texture

Fine lines starting to appear

Loss of firmness

Pigmentation / uneven tone

Breakouts or congestion

6

How would you describe your skin?* This field is required.

Dry or dehydrated

Sensitive or reactive

Normal / balanced

Oily or congestion prone

Not sure

7

Have you had professional skin treatments before?* This field is required.

Never

Occasional facials

Regular facials or peels

Microneedling / advanced treatments

8

Which statement feels most true for you?* This field is required.

My skin just looks dull and needs a refresh

My skin looks more tired than it used to

I’m starting to notice lines or texture

My skin feels less firm than before

9

How much downtime are you comfortable with?* This field is required.

None at all

1–2 days

A few days if results are worth it

10

What is your main goal?* This field is required.

Smoother skin

Skin that looks more rested

Firmer / tighter skin

Overall rejuvenation

Reduced pigmentation

11

Do You have any allergies?* This field is required.Food, ingredients, insects etc.

YESNO

12

Please list allergies if applicable.

13

Are you currently taking any medication or supplements?* This field is required.Prescription, otc etc.

YESNO

14

Please list medication or supplements if applicable.

15

Please list ANY medical condition we should be aware of here.(Including implants and devices such as pacemakers etc)

16

Do you currently use sunscreen daily?* This field is required.

YESNO

17

Your Commitment Style* This field is required.To help me recommend a realistic plan