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Skin Coaching ~ Discovery Session
In order to make the most of our time together, please answer the following questions prior to your scheduled session. Your responses to the questions will help us work together to get to the root of your skin's desires!
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Email
*
Your email
Please continue on if you'd like to find your perfect products!
Full Name
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Phone
*
Your answer
Email
*
Your answer
Please list your past & present medications. Example: Antibiotics, topicals, birth control, retinols.
*
Your answer
How many products are you using morning & evening?
*
Zero. I want to establish a routine.
1 - 3 Products. I like to keep it simple.
4+ Products. I have a routine but I'd like to see more results.
Please list your current supplement regimen.
*
Your answer
Please list your makeup products, include brands & product names.
*
Your answer
Please list your current skincare products, including brands & product names.
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Your answer
Do you use any acne products that contain Benzyl Peroxide or Salicylic acid
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Yes
No
Do you spend time in the sun?
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Yes
No
Are you usually under stress?
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Yes
No
Do you smoke?
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Yes
No
Do you have PCOS (Polycystic Ovarian Syndrome)?
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Yes
No
Are you pregnant or nursing?
Yes
No
Maybe
Clear selection
Please check the boxes on the foods you eat regularly (more than once a month).
*
Fast Food
Seaweed
Wheatgrass
Salt
Sugar
Cacao or Cocoa
Sushi
Dairy
Spirulina
Kelp
Required
Do you have any allergies to food or topicals?
*
Your answer
Are you currently undergoing any skin treatments from a professional?
*
Your answer
What are your desired skin results? (Example: Fight breakouts, reduce fine lines, calm redness, improve texture, etc.)
*
Your answer
What's your skin type?
Always Dry
Sometimes Dry
Combo
Sometimes Oily
Always Oily
Clear selection
Please list your medical history, recent surgeries, etc.
Your answer
Anything else we should know?
Your answer
Send me a copy of my responses.
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