Personal Skin Consultation 1. What is your age?A. Under 18B. 19-29C. 30-39D. 40-49E. 50-59F. 60+2. Which term best describes your skin tone?A. Very fairB. FairC. MediumD. Medium-OliveE. DarkF. Very Dark3. What best describes your skin?A. Oily / Clogged Pores / Severe Breakouts All-OverB. Oily / Combination / Occasional BreakoutC. Oily / Combination / Sensitive / Consistent BreakoutD. Oily / Combination / Sensitive / Occasional BreakoutE. Normal / Sensitive / RedF. NormalG. Dry / Dull complexionH. Dry / Sun DamagedI. Dry / Sensitive / Red4. What are your top 3 skin concerns? A. Acne or Blemishes B. Oiliness C. Clogged pores or blackheads D. Enlarged Pores E. Uneven skin tone F. Redness or Rosacea G. Sensitivity H. Dehydration (skin feels tight but produces oil) I. Dryness (skin is dry and flaky and produces no oil) J. Wrinkles K. Sun damage L. Under eye puffiness M. Under eye dark circle N. Post-breakout scars O. Hyperpigmentation P. Loss of firmness Q. Sagging skin 5. Are you allergic to any specific skincare ingredients?6. Are you a smoker? A. Yes B. No 7. Are you pregnant? A. Yes B. No 8. Are you currently on any topical medication? A. Yes B. No If yes, please specify9. Have you ever used retinoid acid based products? A. Tretinoin B. Retin-A (micro) C. Renova D. Atralin E. Avita F. Accutane 10. Have you had any medical aesthetic treatments in the past three months, or are you planning any? Botox or other wrinkle-relaxing injections Dermal fillers Laser or light treatments (including IPL) Microneedling (with or without radiofrequency) Chemical peels Skin-tightening treatments (such as radiofrequency or ultrasound) Other: None Other:11. What best describes the environment you live in? A. Humid B. Dry C. Neither humid or dry 12. How many hours of sleep do you get everyday? A. Less than 4 hours B. 4-6 Hours C. 6-8 Hours 13. What best describes the stress level in your life? A. Very stressful B. Moderate stress C. Little Stress 14. How diligent do you wear sunscreen?A. NeverB. RarelyC. SometimesD. OftenE. Always15. How frequently do you travel by plane?A. Once a weekB. Once every other weekC. Once a monthD. Once every other month16. How many products do you use in your daily regime? Fewer than 3 3-5 More than 5 17. What are the skincare products you use regularly A. Cleanser B. Toner C. Serum D. Moisturizer E. Facial Oil F. Eye Cream G. Facial Mask H. Eye Mask I. Exfoliators J. Sunscreen 18. What at-home skincare tools or devices do you use regularly? LED light therapy (mask or handheld device) Microcurrent or EMS device Radiofrequency device Facial cleansing device Electronic gua sha or facial massage device Manual gua sha or facial roller Other: None Other:19. What do you hope to achieve with your skincare regime? Radiance Moisturize Smooth/Firm/Lift Soothe Brighten 20. What are your favorite skincare products?21. Why you like the above products?22. What is your email address?Be sure to leave your email so that the results can be sent to you
