Online Skin Guidance***Please be sure to check your junk/spam mail for our response! Name * First Name Last Name Email (Please provide an email that you check regularly, this is how I'll follow up with your Application) * Phone * (###) ### #### Birth Date * MM DD YYYY How did you hear about Skin Junkie/Cherished Skin Solutions? * How would you describe your skin currently? * Normal Skin (small pores on the face with slightly larger pores on the chin and t-zone. Well balanced, neither too oily or too dry, with a smooth texture and few imperfections) Dry Skin (characterized by small pore size all over. Skin never feels oily + drinks in moisturizing products) Oily Skin (Characterized by large pores over the entire face and stays oily throughout the day with a shiny appearance) Please choose the current skin concerns you'd like to address. (Acne is not addressed here. Please email us for the correct online acne questionnnaire) * Sensitive/Redness Hyperpigmentation (darks spots + uneven tone) Aging (fine lines/loss of elasticity/firmness) Excessive Oiliness Large Pores Dark under eyes Rosacea What are your skin goals? * Enjoy makeup free days Vibrant aging without injectables Even complexion Smooth texture Which products are currently using? Please be very specific here. * Of these products, which do you feel have made a difference in your skin? * How often do you use these products? * Typically, we will provide a full regimen recommendation based upon your concerns. If you are ONLY looking for a specific product recommendation (cleanser/serum/etc) please explain below. * Have you ever experienced adverse reactions to any topical products? * How much water do you drink daily? * How is your sun exposure? * Do you sun tan? * Yes No Do you sleep in makeup? * Yes No Do you suffer from eczema or psoriasis? * Do you have any dietary restrictions or allergies? * Are you on any medications that affect your skin? Is there anything else you'd like me to know? * Thank you for this information! Be on the look out for a response within the next 48 hours. Be sure to check your junk/spam folder too!
