Client Skin Consultation Intake
Share your skin background, current routine, and goals so we can tailor your consultation.
Client Basics
Full Name
*
First Name
Last Name
Age
*
Lifestyle notes relevant to skincare (e.g. workout routine, job/schedule, sun exposure, anything affecting skincare timing or habits)
Skin + Goals
Skin type
Oily
Dry
Combination
Sensitive
Normal
Not sure
Biggest skin concern(s) right now
*
How long have you had this concern?
Top 2-3 skin goals
*
History
Have you had professional skin treatments before?
Yes
No
If yes, which treatments, when, and how did your skin respond?
Has any product ever made your skin worse? If so, which product and what reaction?
Any prior skin conditions relevant to your plan, e.g. past acne
Current Routine
AM routine — list every product you use, in the order you apply them
*
PM routine — list every product you use, in the order you apply them
*
Are you currently using any acids, retinoids, exfoliants, or acne medications? If so, which ones and how often?
How does your skin feel through the day?
Oily
Dry
Tight
Sensitive
Combination/varies
Health/Safety Check
Allergies
Pregnancy/nursing status
Not pregnant/nursing
Pregnant
Nursing
Prefer not to say
Are you currently on any prescription topical or oral medications relevant to skincare, such as tretinoin, Accutane, antibiotics, or spironolactone?
Commitment Level
Are you interested in a one-time treatment or a treatment + home care plan?
One-time treatment
Treatment + home care plan
Not sure yet
Are you open to changing your current routine/products?
Yes
No
Open to some changes
Please upload 3 photos of your skin: one from the front, one from the right side, and one from the left side.
*
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Please upload 3 photos: front, right side, and left side.
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