Name *

First Name

Last Name

Phone

(###)

###

####

What is your primary skin goal? *

A) Achieve a clear, blemish-free complexion

B) Reduce fine lines and signs of aging

C) Restore hydration and soothe dryness

D) Brighten and even out skin tone

E) Calm sensitivity and redness

What are your top skin concerns? (Select up to 3) *

A) Acne or frequent breakouts

B) Dullness or lack of radiance

C) Fine lines, wrinkles, or sagging

D) Redness, irritation, or sensitivity

E) Dark spots or uneven pigmentation

F) Dryness or dehydration

What kind of skincare experience are you looking for? *

A) Quick and effective, with visible results

B) Luxurious and relaxing, focused on stress relief

C) Deep cleansing and purifying

D) Hydrating and nourishing

E) Rejuvenating and anti-aging

How would you describe your skin type? *

A) Dry

B) Oily

C) Combination

D) Sensitive

E) Normal

How does your skin usually react to new products? *

A) Often sensitive; it can get red or irritated

B) Usually fine; it adapts well

C) Occasionally sensitive, but mostly okay

D) It’s resilient and rarely reacts

E) I’m not sure, but I’d like to try new treatments

How frequently would you like to get facials? *

A) Once a month for ongoing maintenance

B) Every few months, as a treat

C) Only when I have a specific issue to address

D) Seasonally to keep up with changes in my skin

E) As often as needed for relaxation and self-care

Which option best describes your lifestyle and time availability? *

A) Busy with little time for lengthy facials

B) Flexible schedule, can spend an hour or more on facials

C) Usually on-the-go, so shorter treatments are ideal

D) I love taking my time for self-care

How would you like to feel after your facial? *

A) Fresh and rejuvenated

B) Deeply relaxed and stress-free

C) Purified and cleansed

D) Hydrated and nourished

E) Glowing and radiant

How hydrated do you feel your skin is? *

Very hydrated

Somewhat hydrated

Dry

Very Dry

Have you ever had a professional treatment? *

Yes

No

Are you taking any medication? *

Yes

No

How often do you wear SPF (sunscreen)? *

Everyday, regardless of the weather.

Only on sunny days

Occasionally, when I remember

Never, I don't think it's necessary