Skin Consultation Intake
Share a few details about your skin, routine, and sensitivities so we can email tailored guidance within 24–48 hours.
• About You •
A few details to help me personalize your care
First name
*
Email
*
example@example.com
Yes, send me skincare guidance and occasional updates from PureButterMelts.
Yes, send me skincare guidance and occasional updates from PureButterMelts.
Your Skin
How would you describe your skin?
*
Please Select
Dry
Oily
Combination
Normal
Sensitive
Not sure
What are your top skin concerns right now?
*
Dryness or flaking
Dullness or uneven tone
Dark spots or hyperpigmentation
Body breakouts
Facial breakouts
Keratosis pilaris (chicken skin)
Itchiness or irritation
Razor bumps or ingrown hairs
Eczema-prone or reactive skin
Loss of firmness
Something else
Where on the body?
Face
Arms
Legs
Back
Chest
Hands
Feet
Intimate area
All over
Is your skin currently broken, raw, or irritated anywhere?
Yes
No
Sometimes
Your Current Routine
What do you cleanse with now?
What do you moisturize with now?
How often do you moisturize?
Please Select
Daily
A few times a week
Occasionally
Rarely
Do you exfoliate?
Please Select
Never
Occasionally
1-2 times a week
3 or more times a week
Sensitivities & Safety
Any known allergies or sensitivities? Please list them, or write none.
*
Are you currently using prescription skincare or under a dermatologist's care?
*
Yes
No
If yes, what are you using?
Are you pregnant or nursing?
*
Yes
No
Prefer not to say
Fragrance preference
Please Select
I love scent
Light scent only
Fragrance-free please
A Little Context
What is your climate like?
Please Select
Hot and humid
Hot and dry
Cold and dry
Mild or temperate
Four distinct seasons
Anything else you would like me to know about your skin?
Before You Submit
I understand this consultation provides general skincare education and product guidance, not medical advice.
*
I understand this consultation provides general skincare education and product guidance, not medical advice.
Send My Intake
Should be Empty: