Safer Skin Care Consultation
Please fill out the form below to get more information about the best products for your skin. If you're interested in a Whole Life Detox consultation (home products). Please email
What type of skin do you have?
Oily (dull or shiny complexion, blackheads and breakouts more common, large pores common)
Normal (no or few blemishes, balanced, etc.)
Dry (dull or rough complexion, irritation common, flaky)
Combination (areas of both dry and oily skin, usually along the forehead nose and chin)
Sensitive (does not tolerate many products well, redness, irritation, itchy, burning common)
What are your skincare concerns? (check all that apply)
Large pores or blackheads
Acne scars from historic acne
Aging (fine lines, wrinkles, loss of elasticity)
Dullness or uneven skintone
Hyper pigmentation (melasma, sun damage, dark spots, etc.)
General overproduction of oil
Skin spots or discoloration
Eczema or dermatitis
A known reaction to skincare products
If you have had a reaction to skincare products in the past, please tell me more about which product(s) you reacted to and what type of symptoms you experienced.
What does your current skincare routine consist of? Please include the following information: Product and brand name, time of day used (i.e. morning or night), list products in order of application.
Do you have a budget in mind? If so, what range would you like to stay in to get started? Keep in mind I will provide you with 3 different options that will allow you to pick and choose products to stay within budget
Less than $50
$200 or more
I’m open, depending on what is needed
Are you interested in hearing about our cosmetic line and receiving recommendations on products?
No, not at this time.
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.
Please list any other concerns or question you might have here I am happy to support you any way that I can!
Is there a specific Beautycounter product that you are interested in trying?
Do you want to be added to my email list? You will get updates on new products, promotions & gifts as well as recipes from BonAippetit.com.
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