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What are your current skincare goals? What issues would you like to address?
What kind of breakouts do you experience? Blackheads Whiteheads Cysts - subsurface, red, painful The classic pimple
What skincare products are you currently using? How do you feel they are working well for you? What statement best describes your skin. (Check all that apply) My skin feels pretty good and is not overly oily or dry My skin sometimes feels dry like the desert My skin starts out okay in the morning, but dries out as the day goes on My skin feels dry even after I use moisturizer My cheeks feel dry and sometimes look flaky My skin is pretty oily My skin is oily only in the T-zone Moisturizers can be too much for my skin My skin starts to look shiny as the day goes on My skin looks dull and lacks vitality What is your morning skincare routine? What is your evening skincare routine? Do you have any allergies to skincare products? If so, what are they? What happens when you have a reaction?
How much time do you spend in the sun? Check all that apply 0-30 minutes per day 1-2 hours per day 2-3 hours per day 3-4 hours per day 4+ hours per day Do you use sunscreen? YesNo If yes, how often do you reapply? What brand do you use and what is the SPF? Have you ever had a reaction to sunscreen products? If yes, what was the brand and what was the reaction? Do you have any dietary restrictions or allergies? If so, what are they? Do you notice any seasonal changes in your skin? If so, please explain? Do you exercise? YesNoWhen I can, no set routine Do you clean your face before and after exercise? YesNoSometimes What do you use to clean your face after exercise? Do you currently smoke? YesNoSometimesNot anymore How much water do you drink in a day?
Please list any prescription medications you are currently taking Do you have any diagnosed conditions? Is there anything else you would like us to know?
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