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Eighteen B Skincare Consultations
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Name
*
Your answer
Email Address
*
Your answer
Phone (best number to reach you)
*
Your answer
How would you prefer to conduct your skincare consultation?
*
Phone Call
Zoom Call
Email Correspondence
Age Group
*
Under 30
30 - 39
40 - 49
50 - 59
Over 60
What is your skin type?
*
Oily
Combination
Normal
Dry
What is your skin concern?
*
Your answer
What state do you live in?
*
Your answer
Do you currently use Eighteen B products?
*
Yes
No
Sometimes
Describe your current skincare routine, including brand names if possible.
*
Your answer
Anything else you would like to share (skin allergies, pregnancy, etc)?
Your answer
Would you like to opt into our mailing list?
*
Yes
No
Would you like to opt into receiving text messages from us?
*
Yes
No
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