Form for Skincare Consultation

1. What is your age?

2. Which term best describes your skin tone?

3. What best describes your skin?

4. What are your top 3 skin concerns?

5. Are you allergic to any specific skincare ingredients?

6. Are you a smoker?

7. Are you pregnant?

8. Are you currently on any topical medication?

If yes, please specify

9. Have you ever used retinoid acid based products?

10. What best describes the environment you live in?

11. How many hours of sleep do you get everyday?

12. What best describes the stress level in your life?

13. How diligent do you wear sunscreen?

14. How frequently do you travel by plane?

15. How many products do you use in your daily regime?

16. What are the skincare products you use regularly

17. What beauty device(s) do you use in your skincare regime?

18. What do you hope to achieve with your skincare regime?

19. What are your favorite skincare products?

20. Why you like the above products?

21. What is your email address?