Get Started Skin Care QuestionnaireI need a information to help me put together a skincare program that’s just right for you. Please answer the questions below and let’s get started! Name * First Name Last Name Email * Instagram * What are your biggest skincare concerns? What type of skin do you have? Oily Dry Oily in the T-zone Sensitive or Reactive Normal If you break out, how often? Yes, a few per month. Yes, consistently. Do you pop or pick at blemishes? Yes No If so, are you willing to break that habit? Yes No Does your skin sting, burn, or get red and irritated when you apply your skincare products? Yes No Are you currently taking any prescription medication or birth control? If so, please list here. Do you use over the counter supplements, energy drinks, pre/post workout drinks, or protein powder? If so, please list all here. Have you recently changed any medications, supplements, or birth control? How many hours of sleep do you get? Is your sleep amount consistent? Yes No What is your stress level on a scale from 1-10? 1 2 3 4 5 6 7 8 9 10 Do you consume whey or dairy protein? Yes No Do you drink a lot of coffee or soda? Yes No Are you pregnant or nursing? Do you smoke? Yes No Do you drink alcohol? Yes No If yes, how many drinks per week? Do you spend a lot a time in the sun? Yes No How many hours do you work per week? Are you located in the Memphis, TN area? Yes No If yes, would you be willing to do in-office treatments to help clear you skin faster or address scarring? Yes No Would you prefer in-office or virtual treatments? In-office Virtual Is there any other information related to skincare you would like to share? Please upload 3 photos taken in good lighting. One from the front, left and right. FileField; MaxSize=1000KB; Multiple; addText=Upload_Your_Photos Thank you! What happens next?Once you click submit on your questionnaire, I will review everything and get back to you as soon as possible! “Frances gave my daughter a road map to follow for her specific type of acne and her sweet confidence returned!”~Amy E.
