Skincare Consultation

Name

Email Address

Birthday

Allergies | Medication | Supplements

Current Health (Diagnosed Conditions, Lifetsyle, Stress Levels, Anxiety...)

Health History

Current Skincare Routine & Treatments

Previous Skincare Routines & Treatments

How Would You Describe Your Skin (Appearance, Texture, Response to heat or products)

Any Redness? Any Redness? Temporary Permanent None

Texture Texture Dry & Flaky Taut & Tight Oily Normal

Appearance Appearance Pigmentation Reddening Dull Open Pores Slack / Loss Of Tone Broken Capillaries Dark Shadows - Eyes Puffiness - Eyes

Environment (Where Do You Spend Most Of Your Time? | Tick all that apply) Environment (Where Do You Spend Most Of Your Time? | Tick all that apply) Indoors Outdoors Hot Climate Cold Climate

Number