Skin Assessment
This form is to assist me with creating a customized treatment plan for your hair and or Skin for amazing life changing results! Vegan, anti aging Hair and Skin line designed to offer undeniable results!


My Skin is *
I break out *
I tend to
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Do you wear makeup
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I drink water
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I drink soda
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I drink alcohol
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I treat my skin professionally
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Do you have a consistent home care regimen
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Is Anti Aging a big factor or concern for you
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Do you struggle with puffiness or Under eye circles *
Do you feel like you have tried many other products with no results
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What are your main concerns with your skin and if you could focus on one or two things specifically what would that be *
Are you interested in detailed information of recommended products and how they will help with your skin
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I’m interested in
What is your Instagram Name or Name & Phone number and best time to be reached *
What is your Instagram Name or Name & Phone number and best time to be reached *
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