Custom Beauty & Wellness Consult

1
What is your name?* This field is required.
First Name
Last Name
2
What is your email address?* This field is required.
example@example.com
3
What is your phone number?* This field is required.
Please enter a valid phone number.
4
Which of these applies to you?* This field is required.
I've never ordered from Neora before
I am your customer
I am a customer of another Brand Partner
I am a Neora Brand Partner
5
Do you have any allergies?
6
What are you MOST hoping to improve with your skin right now? (Choose all that apply)* This field is required.Yes, these are real Neora results!
Fuller Lips
Fine Lines & Wrinkles
Redness & Sensitivity
Acne or Congestion
Texture
Enlarged Pores
Dryness or Dullness
Dark spots or uneven tone
Under-eye concerns (bags, circles, puffiness)
Loss of Firmness / Skin Starting to Sag
Deep Lines or Folds (smile lines, marionette lines, nasolabial folds)
Overall Signs of Aging
SKIP! I'm just here for the haircare or wellness
7
How would you describe your skin type?* This field is required.
Oily
Combination
Normal
Dry
8
Have you ever had irritation from brightening serums (like Vitamin C)?* This field is required.
No, my skin handles them well
Yes, I’ve reacted before
I’m not sure
9
Which best describes your skincare style?* This field is required.
I want to start with the basics and add targeted products over time
I want a strong routine but don’t need everything today
I’m an “I want it all and I want it now” person
10
What’s your ideal monthly budget for skincare?* This field is required.Different products last different lengths of time (some 30 days, some 60–90+), and I want to help you get the most bang for your buck. Every time you order, you earn cashback toward your next month’s purchase — so I’ll map out exactly what to order and when so you stay within your budget while getting the best results.
Under $100 a Month
$100–$150 / month
$150–$200 / month
$200+ / month
Money isn’t the issue — build me the best routine
11
What are your primary hair concerns?* This field is required.(Select all that apply.)
Hair thinning or shedding
Damage / breakage
Scalp issues (flaking, buildup, itchiness, imbalance)
Dryness, frizz, or lack of shine
Male-pattern thinning (receding hairline or crown)
SKIP - I'm just here for the skincare or wellness!
12
How thick is your hair strand?* This field is required.(TIP: Hold a single hair strand between your fingers. If the strand is barely visible to the eye, you have fine hair. If you can easily feel it, your hair is of medium texture. If running your fingers along the strand reveals a slightly rough texture and noticeable strength, you possess coarse hair.
Fine
Medium
Coarse
13
How often do you wash your hair?* This field is required.
14
How often do you feel your hair needs extra hydration?* This field is required.
Occasionally, for a boost of shine
Rarely, it tends to get oily fast
Frequently, to improve softness and manageability
15
What are you MOST hoping to improve with your overall wellness right now? (Choose all that apply, or SKIP if you'd like to skip this section. )* This field is required.
Low energy or feeling run down
Trouble sleeping or waking up refreshed
Brain fog or difficulty focusing
Stress or mood support
Gut/digestion issues
Immune support
Cravings or appetite control
Weight management (lose, maintain, or tone)
Boosting metabolism
Feeling “puffy” or inflamed
SKIP
16
What’s your primary weight goal?* This field is required.
Weight Loss
Overall Toning / recomposition
Post GLP-1 Maintenance/Toning
17
What feels like your biggest obstacle?* This field is required.
Cravings
Slow metabolism
Low energy
Stress eating
Inflammation / bloating
Inconsistent routine
18
How do you prefer to stay motivated on your health + wellness journey?* This field is required.
I love being part of 30–90 day challenges
I want simple text reminders to keep me consistent
I like accountability groups or community support
I enjoy learning—education, tips, etc
I prefer to do things on my own
I’m not sure yet — open to whatever you think will help most
19
Do you feel like you’re getting the recommended amount of fruits and veggies each day?* This field is required.
Yes, most days
Some days
Not really
Definitely not
20
Are you sure you don't want skincare recommendations?
Ok, let's do it!
I already have perfect skin
21
Ok let's figure out your skincare routine together! What are you MOST hoping to improve with your skin right now? (Choose all that apply)* This field is required.Yes, these are real Neora results!
Fuller Lips
Fine Lines & Wrinkles
Redness & Sensitivity
Acne or Congestion
Texture
Enlarged Pores
Dryness or Dullness
Dark spots or uneven tone
Under-eye concerns (bags, circles, puffiness)
Loss of Firmness / Skin Starting to Sag
Deep Lines or Folds (smile lines, marionette lines, nasolabial folds)
Overall Signs of Aging
22
How would you describe your skin type?* This field is required.
Oily
Combination
Normal
Dry
23
Have you ever had irritation from brightening serums (like Vitamin C)?* This field is required.
No, my skin handles them well
Yes, I’ve reacted before
I’m not sure
24
Which best describes your skincare style?* This field is required.
I want to start with the basics and add targeted products over time
I want a strong routine but don’t need everything today
I’m an “I want it all and I want it now” person
25
What’s your ideal monthly budget for skincare?* This field is required.Different products last different lengths of time (some 30 days, some 60–90+), and I want to help you get the most bang for your buck. Every time you order, you earn cashback toward your next month’s purchase — so I’ll map out exactly what to order and when so you stay within your budget while getting the best results.
Under $100 a Month
$100–$150 / month
$150–$200 / month
$200+ / month
Money isn’t the issue — build me the best routine
26
Are you sure you don't want haircare recommendations?
Ok, let's do it!
I already have a perfect hair routine
27
What are your primary hair concerns?* This field is required.(Select all that apply.)
Hair thinning or shedding
Damage / breakage
Scalp issues (flaking, buildup, itchiness, imbalance)
Dryness, frizz, or lack of shine
Male-pattern thinning (receding hairline or crown)
28
How thick is your hair strand?* This field is required.(TIP: Hold a single hair strand between your fingers. If the strand is barely visible to the eye, you have fine hair. If you can easily feel it, your hair is of medium texture. If running your fingers along the strand reveals a slightly rough texture and noticeable strength, you possess coarse hair.
Fine
Medium
Coarse
29
How often do you wash your hair?* This field is required.
30
How often do you feel your hair needs extra hydration?* This field is required.
Occasionally, for a boost of shine
Rarely, it tends to get oily fast
Frequently, to improve softness and manageability
31
Before I build your routine… do any of these matter to you?
Firmer-looking skin / cellulite solution
A natural, believable sunless glow with clean ingredients
Everyday sun protection or blue-light protection
Fuller/longer lashes or brows
Instant wrinkle reducer (with long term benefits)
Nope, I’m good!
32
And you are sure you don't want to discuss any of these issues? My clients (and myself) have seen HUGE improvements in these categories and I'd like to help you, too!* This field is required.
Low energy or feeling run down
Trouble sleeping or waking up refreshed
Brain fog or difficulty focusing
Stress or mood support
Gut/digestion issues
Immune support
Cravings or appetite control
Weight management (lose, maintain, or tone)
Boosting metabolism
Feeling “puffy” or inflamed
I'm good, thank you!
33
Last question… * This field is required.Share anything that helps me understand your ideal monthly budget, your main priorities, or anything else you’d like me to know. I want to build the best routine that gets you real results while staying aligned with your goals. 🤍
Huge
Large
Normal
Small
Ok
Ok
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