Name(Required) First Last Phone(Required)Email(Required) Date of Birth(Required) MM slash DD slash YYYY Preference of Consult Zoom FaceTime Google Duo Phone Call In-Person (Overland Park, KS) Skin Type(Required) Dry Dry-Normal Normal Normal-Oily Oily Acne Prone Hormonal Breakouts Do you have any skincare conditions?(Required) Yes No i.e. Acne/Rosacea/Eczema/Lupus/etc.If so, please list. Do you have any skincare ingredient allergies?(Required) Yes No If so, please list. List your top 3 skincare concerns in order:(Required) 2 3 What would you like to primarily focus on?(Required)What type of skincare products are you currently using?(Required) Multilevel Marketing/OTC/Drug Store/Online High-End Department Store/Online Medical Grade Skincare None What types of skincare products are you currently using?(Required) Cleanser Toner Serums Moisturizer Sun Protection/SPF Eye Cream Exfoliants/Scrubs Masks Retinol Products containing: Glycolic, Lactic, AHA or BHA's Do you currently have a daily skincare routine?(Required) Yes No What do you feel that you are missing/lacking from your current skincare regime?(Required)Do you receive regular facials?(Required) Yes No If so, how often? We may make suggestions and recommendations based on our expertise, are you comfortable with that?(Required) Yes No Do you feel you are ready to commit to a result-oriented skincare regime?(Required) Yes No This will include daily steps/potential introduction of new products and consistency.What is your timeframe for seeing results? Immediate 3 Months Long-Term Select AllWhat do you think is attractive about your face? What do you love about yourself? (personality/character) What are you grateful for today?
