skin check-in 🤎
this form helps me see how your skin is responding to your current routine + treatments so I can decide if we’re staying exactly where we are or if it’s time to make any adjustments. please answer as honestly as you can + upload your current progress photos at the end. once I review everything, I’ll follow up with you with your next steps! xx, cel
Name
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How do you feel your skin is doing overall?
Improving a lot
Improving a little
About the same
Getting worse
What are you noticing right now? (Select all that apply)
Fewer breakouts
More breakouts
Less redness/inflammation
More redness/inflammation
Less congestion/texture
More congestion/texture
Dryness/flaking
Oiliness
No major changes
Other
Are you still getting new breakouts?
Rarely/none
A few per week
Regularly
More than before
Where are you currently breaking out? (Select all that apply)
Forehead
Cheeks
Chin
Jawline
Around mouth
Neck
Chest/back
Other
How consistently are you following your prescribed routine? (Select the option that fits best)
Following my AM + PM routine as directed
Consistent with AM, but sometimes miss my PM routine
Consistent with PM, but sometimes miss my AM routine
I regularly miss certain products/steps
I’m not very consistent with my routine right now
Have you stopped or changed any of your recommended products?
No
Yes
If answered yes above, which products and why?
Have you added anything new since your last check-in? (Skincare, makeup, hair care, medications, supplements?)
Are you experiencing any irritation? (Select all that apply)
Dryness
Flaking
Tightness
Redness
Itching
Stinging/burning
Swelling
Rashes
None
Have there been any changes that could be affecting your skin? (Select all that apply)
Hormones/cycle
Medication/birth control
Supplements
Stress
Diet
Travel
Exercise/sweating
Hair or makeup products
Nothing I can think of
Anything else you want me to know or have questions about?
Upload your progress photos. REQUIRED: front, left side + right side
Browse Files
Drag and drop files here
Choose a file
Please take photos with clean, makeup-free skin in good natural lighting. No filters or beauty mode. If possible, use the same lighting/location each check-in.
Cancel
of
Submit
Should be Empty: