Full Name
Phone
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How does your skin typically feel after cleansing?
Tight or dry
Comfortable
Oily or shiny
Dry in some areas and oily in others
How would you describe your skin by midday?
Mostly dry or flaky
Balanced
Noticeably oily or shiny
Oily in my T-zone but drier elsewhere
What is your biggest skincare concern right now?
Breakouts or acne
Dark spots or hyperpigmentation
Dryness or sensitivity
Texture, pores, or congestion
How often do you experience breakouts?
Rarely
Occasionally
Frequently
Almost constantly
How would you describe your pores?
Barely visible
Small and mostly visible around my nose
Noticeable throughout my face
Larger and prone to congestion
Does your skin tend to react to new skincare products?
Rarely
Sometimes
Frequently
Almost always
How would you describe your skin tone and pigmentation?
Even overall
Some areas are darker than others
I have noticeable dark spots or post-acne marks
I struggle with uneven pigmentation regularly
What does your current skincare routine look like?
I have a consistent routine
I have a basic routine
I use products occasionally
I’m not sure what products I should be using
What is your biggest skincare goal?
Clearer skin and fewer breakouts
Brighter, more even-looking skin
Smoother texture and smaller-looking pores
Healthier, more hydrated skin
How would you prefer to receive personalized skincare guidance?
In-person in Jacksonville, Florida
Virtually from anywhere in the U.S.
I’m open to either
I’m not sure yet