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Pre-Questionnaire Virtual Consultation

Birthday
Month
Day
Year

SKIN TYPE & CONCERNS

How would you describe your skin type?
Oily
Dry
Acne-Prone
Sensitive
Combination
Normal
What are your primary skin concerns? (Select all that apply)
How long have you been experiencing these concerns?
Less than 3 months
3-6 months
6-12 months
More than a year
Does your skin feel tight or dry immediately after cleansing skin?
Yes
No
Are you able to take your products with you while you travel?
Yes
No
Have you had any skincare treatments done within the last year?
Yes
No
How often do you use the above products?
Daily
2-3x Week
Weekly
Occasionally

Lifestyle & Habits

How much water do you drink daily?
Less than 1 liter
1-2 liters
More than 2 liters
Unsure
How would you describe your diet?
Balanced and healthy
High in processed foods
High in sugar
Vegetarian/ Vegan
Other
Do you smoke or drink alcohol?
Yes, Both
Yes, Smoke
Yes, Drink
No
How often do you exercise?
Daily
Several times a week
Occasionally
Rarely/ Never
How many hours of sleep do you get on average per night?
Less than 5 hours
5-6 hours
7-8 hours
More than 8 hours
Do you wax, shave, trim, sugar, or laser hair?
Do you get Botox or filler?
Yes
No
Do you work indoors or outdoors?
Indoors
Outdoors
Both
How often do you wear full coverage makeup?
Everyday
Sometimes
Weekends Only
Special Occasion

Medical History

Goals & Preferences

What are your skincare goals?
What are your skincare goals?
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