SKIN consultation FORM: Name * First Name Last Name Email * Phone Number (###) ### #### Age Select the age bracket you fit under: 16-25 26-35 36-45 46-55 55+ Skin Type Normal - Healthy oil flow around nose only (not enough to notice oil) Dry - Your skin shows NO signs of oil what so ever. Often feels "dry", flaky areas. Combination - Oily in the T-Zone (between the brows, nose, inner cheeks, chin), and dry (no oil) on the sides of the face. Oily - Oil flow over the entire face Skin Conditions Dehydration Pigmentation Premature Ageing Sensitivity Acne/Breakouts/Excess Oil Blackheads/Whiteheads Dullness I am currently using: Cleanser Toner Exfoliant Mask Moisturiser Serums Eye care Night Oil Makeup Sunscreen Soap Self-Tan I am currently using the following brands: What do you love/dislike about these brands and how they work? Are you using any acne medication, Retina-A, Renova, Retinol, Vitamin A, Glycolic, Lactic Acid products at home/in other salons? Skincare Budget * Roughly how much would you like to be spending on a whole routine, and how many products would you like to be using? Have you ever had any allergic reactions? If so, please list: Skincare preference Do you have a preference? Organic/natural Active/Corrective Are you pregnant, trying or breastfeeding? Are you taking any medication? Is there anything else you'd like to tell me or ask me? Please initial below to promise you have answered all questions above truthfully, and to the best of your knowledge. Thank you! We will be in contact with your shortly!
