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Feminology Clinic One-on-one Application
Welcome to the Feminology Clinic application form. If you'd like to apply to work one-on-one please complete the following questions and book in your FREE Acne Assessment call. Thank you for being here, and please know all of your information will remain strictly confidential. Our one-on-one solution only supports clients in the United Kingdom at this time. 
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Email *
First name *
Surname *
Email address *
Phone number *
Date of birth *
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Do you live in the UK? I am only able to currently help clients in the UK. *
Required
How did you hear about me? (If someone referred you, let me know who) *
What kind of support and outcomes are you seeking? What is your goal? *
Tell me about your acne history to date (for example: when did it start? Was there a trigger? Has it been consistently occurring or does it come and go?) *
How long have you been trying to clear up your acne for? *
Required
What are your top 3 health goals in order of importance to you? (For example: 1. facial acne 2. bloating 3. weight gain). *
Tell me a bit more about these symptoms (for example: when did they begin? What makes them worse or better? How severely are they affecting you?) *
What medications and/or other therapies have you tried to resolve your acne? Let me know if any worked. For example: Antibiotics, Hormonal Birth Control, Roaccutane, Spironolactone, Supplements, Testing, Elimination diets.  *
If you're currently still taking a medication like hormonal birth control for your acne - would you like to be able to transition off of it? *
What do you think has prevented you from achieving clear skin and your other health goals on your own? *
Over the years how much do you think you have financially invested in trying to solve this on your own? (Skincare, dermatologist appointments, supplements, health trends, programs, other practitioners).  *
Healing takes commitment, and personal investment into the process. I want to make sure you're ready to do the work. How committed are you? *
On the fence
All in
For long-term and optimal results my clients work usually with me for a minimum of 4 months. Can you commit to this timeframe? *
Required
One-on-one support is a monthly investment of £875 (incl. herbal medicines + HTMA test). Functional testing costs vary + monthly supplement requirements vary (£50-200). Are you ready and able to make this investment?  *
Required
After your FREE Acne Assessment Call, if you proceed with one-on-one support, what is your ideal starting timeline? *
Required
Please use this space to write out any questions or to provide more detail about your health history.  *
I understand that by submitting this form and booking in a call I am not only taking a spot away from another acne sufferer in need, but I am also taking away time out of Charlotte's day. (While the call is free, if you do cancel/reschedule without giving 24 hours notice, there will be a £40 no-show fee).  *
Required
Thank you for completing the application form. You can then book in your FREE 30-minute Acne Assessment Call to discuss the support I can provide, expectations, timelines and suitability. 
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