The Clear Skin Method
Thank you for your interest in The Clear Skin Method™ by Amy Scott — a 12-week functional acne healing programme for those who want to address acne at the root.This form helps me understand whether the programme is a good fit for you. Once reviewed, you’ll be contacted with next steps if a spot is available.
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Skin History:
For Example; How long have you been experiencing acne? Where do you experience breakouts? Is it worse at certain times of the month?
What have you tried to help your skin so far?
Please include any medication, prescription creams, Treatments etc
Are you willing to commit to a 12-week programme with weekly check-ins?
Yes
No
Maybe
Are you looking for short-term relief or long-term healing?
Please Select
yes
Possibly
no
Why do you feel drawn to a functional, root-cause approach?
Are you currently on Contraception?
yes
no
If you answered yes to the above question, please specify which contraception you are on below. (please note that in order to be suitable for bloodwork, you will need to be off contraception for at least 3 months prior)
Please confirm the following:
I understand results are not guaranteed and vary between individuals
I understand this is not medical treatment
Acne healing is not linear
Please Upload a photo of your skin
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