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Area Code
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Birthday
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Date
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5
Instagram handle
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Is your skin:
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7
Do you have:
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Sun spots
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Do you have:
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Do you have acne?
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Do you have large pores?
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Do you have dark under eye circles?
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12
What would you like to change about your skin?
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13
What is your biggest skin goals?
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14
What is your current skin care routine & products?
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15
How do you prefer I contact you to get you your results & your customized skin care?
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