Skin Analysis Form
Hey gorgeous! I have been an aesthetician for 26 years and counting💕 I’d love to help you build a custom skincare routine that fits your goals and lifestyle.Can you answer a few quick questions for me? It’ll take less than 2 minutes 🌸
What is your main skincare goal right now?
*
Hydration
Glow
Even tone
Anti-aging
Acne care
Other
How would you describe your skin type?
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Dry
Dehydrated
Oily
Combination
Normal
Sensitive
Are there any specific areas or concerns you’d like to target?
Fine lines
Dark spots
Redness
Breakouts
Other
What does your current skincare routine look like? Do you have both a morning and evening routine?
Do you currently use any active ingredients in your skincare products? (e.g., retinol, vitamin C, AHA/BHA, niacinamide, etc.) Please list them.
Have you ever experienced sensitivity, redness, or reactions to skincare?
Sensitivity
Redness
Reactions
None of the above
Other
Is pigmentation or uneven skin tone something you’d like to address?
Yes
No
How would you describe your skin texture — smooth, rough, bumpy, flaky?
Smooth
Rough
Bumpy
Flaky
How does your skin feel at the end of the day — tight, shiny, or balanced?
Tight
Shiny
Balanced
Do you use sunscreen daily? If yes, what kind?
Yes, mineral sunscreen
Yes, chemical sunscreen
Yes, tinted sunscreen
Yes, SPF moisturizer
No
Would you prefer a simple routine or are you open to a multi-step regimen?
Simple routine
Multi-step regimen
Open to either
Are there any lifestyle factors that might affect your skin (stress, travel, sleep, diet, environment)?
What amount of investment are you looking to put towards your skincare goals
Instagram profile
Email
example@example.com
Cell Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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