Consultation Form
Your information will always be private and will be used only for your product recommendations. Do you wax your face on a regular basis?
Does your job and/or lifestule require that you work/play outdoors?
Have you ever had facials, chemical peels, microdermabrasion or any resurfacing treatments?
Are you using Benzoyl Peroxide?
Tell me about any health issues you have:
Skin Characteistics: click all that apply
How often do you wear make up?
Currently using: click all that apply
Have you ever experienced a reaction to the following?
Where do you fall on the Fitzpatrick Skin Type
Starting budget for new skincare regimen
Desired skincare regimen.
I have read and completed this questionnaire truthfully. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments or products received. The treatments or products I receive are voluntary and I release the company and/or skin care professional from liability.
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