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Skin Consultation
Let's get you ready for a skin consultation!
First Name
Last Name
Email
Phone
What are your main skin concerns ?
Sensitivity
Redness
Hyperpigmentation
Acne
FIne lines & Wrinkles
Dryness
Loss of firmness or elasticity
Other
Are you concerned with dark circles under or around the eyes?
Extremely concerned
A little concerned
Somewhat concerned
Not concerned
How would you describe your skin type?
Dry
Neutral/Normal
Combination
Oily
How would you describe your skin tone?
Very Fair/Very Light
Fair/Light
Olive or Medium
Light Brown
Dark Brown
Very Dark
Not sure
How old are you?
20 or below
21-26
27-33
34-39
40-46
47-54
55-64
65+
What is your gender?
Female
Male
Non-binary
I'd rather not say
Are you pregnant or breastfeeding or about to be?
No
Yes
Anything else you believe we should know?
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