Skin Care Questionnaire

What face will you show to the future?

There are many factors to consider before choosing effective skin products that enable me to better serve your individual skin care needs.
Please check the appropriate boxes that best reflect you skin condition. The answers to the following questions will help guide us in developing your individualized skin care treatment program.

How do you prefer to be contacted?*
After I wash my face, it usually feels oily:
I would describe my skin as:
I am dieting:
I smoke:
I use sunscreen:
My level of stress is:
I get blemishes:
My skin becomes red and irritated:
My skin has dark spots or discolorations:
I am currently using the following products:
Are you currently experiencing any challenges with your skin? If so, please explain:
What are your primary skin care concerns?
I am interested in:
Thank you for providing me with this helpful information. Please submit this questionnaire to me for a free skin care evaluation and professional recommendations in helping you to achieve your specific skin care needs.
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