BSR_Skincare Intake Form
Email address *
Your name: *
Your answer
How old are you?
What would you consider your skin type? *
Do you have any of the following skin concerns? *
If you have had a reaction to skin care products before, please tell me more about what products and what symptoms you exhibited?
Your answer
What does your current skincare routine consist of? (Please list when you use them i.e. morning or night, the order of application, and the brand/company) *
Your answer
Do you have a budget in mind? If so, what range would you like to stay in to get started? *
Are you interested in hearing about our makeup line and recommendations on product? *
If interested in cosmetics, please tell me a little bit about which products you currently use and would be interested in replacing with safer options.
Your answer
Are you interested in becoming a consultant? *
Please list any other concerns or questions you might have here. Happy to help as much as I can! *
Your answer
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