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Deep Pore Cleanser
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220,00
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Name
*
First
Last
Email
*
Contact Number
Preffered Method Of Contact
*
Whatsapp
Email
Age
*
to lot of
Skin Type
*
Oily
Dry
Combination
Normal
Sensitive
Skin Concerns
Acne
Wrinkles
Dark Spots
Redness/Irritation
Dullness
None
Other
Current Skin Care Routine
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Please Provide any moisturizers, cleansers, Sunscreens, Treatments and Serums (with their brand names included)
Do you have any known allergies or reactions to skincare products?
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Lifestyle Factors
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Include: Diet (balanced, high in sugar, etc.) , Water intake (low, moderate, high), Sleep (hours per night) , Stress levels (low, moderate, high)
Do you use sunscreen regularly?
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Do you spend a lot of time outdoors?
*
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Past Skin Treatments
Have you had any professional treatments? (Facials, chemical peels, etc.)
Did you use any of the following in the last 3 months?
Roaccutane
bleaches
glutamate iv or supplements
Fairness Creams (white gold, himalaya products, etc.)
Cortisone
Eczema psoriasis preps
Kligmans Formula
Retin a
Retinol
Peels
Blood thinning or clotting drugs
Hydroquinone Creams
Lasers
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