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Skin Care Questionnaire
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Name
Your answer
Phone number & instagram handle
Your answer
Describe your skin
Dry
Oily
Combination
Clear selection
Do you have sensitive skin?
Yes
No
Clear selection
Do you have sun damage?
Yes
No
Clear selection
Do you have discoloration?
Yes
No
Clear selection
Do you have fine lines and wrinkles?
Yes
No
Clear selection
Do you have acne?
Yes
No
Clear selection
Do you have large pores?
Yes
No
Clear selection
Do you have dark circles?
Yes
No
Clear selection
Do you have baggy, loose skin?
Yes
No
Clear selection
Do you have puffiness under your eyes?
Yes
No
Clear selection
What are your skin goals?
Your answer
What is your current skin care regimen including products used?
Your answer
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