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CONSULTATION FORM
1. Are you?
Female
Male
2. How old are you, if you don't mind us asking?
20s
30s
40s
50s+
3. How do you moisturize your face?
Oil
Lotion
Thick Cream
I don't really moisturize
4. What concerns (if any) do you have with your skin?
Hyperpigmentation and/ or uneven skin tone
Breakouts and/ or blackheads
Dry and rough texture
Rosacea and/ or redness
My skin is in good shape - just want to keep it healthy
5. Any bad skin habits? We won't judge.
I love tanning
I sleep in my makeup sometimes
I pick and pop my pimples
None, I'm super conscientious about taking care of my skin
6. How would you describe your skin?
Normal
Oily
Dry
Combination
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