Please fill out this  Two Week Follow Up form so we can monitor your progress and make any changes to your products and routine!
After we review your follow up form and look at the photos you email, we will see if any changes to your customized  morning and evening skincare routine are necessary!  
If new products are recommended they will be sent after we receive all your information and paid invoice!

Two Week Follow Up!

Are you a student? What grade:*
Are you currently under a lot of stress?*
Women: Do you use birthcontrol pills, shots or use an IUD? If yes, what brand
Women: Are you pregnant or nursing?
Men: Do you have irritation shaving? If Yes, what type of razor do you use for shaving?
Diet: Have you consumed any of the following in the past 2 weeks?*
Medical History (check all that apply)*
Have you seen a Dermatologist in the past 2 weeks?*
Have you started any prescription medications since your Initial consultation form?*
Are you allergic to any of the following?*
If you checked "other", what allergies do you have?*
Do you smoke?*
Have you used fabric softener in past 2 weeks?*
Have you swam in a chlorinated pool in the past 2 weeks?*
Do you work around chemicals, tars, oils, grease or inks?*
Do you work nights?*
Have you done any of the following procedures in the past 2 weeks:*
Tell me how you are doing with the new program! Are you struggling with anything? Do you have any questions? Is the portal easy to follow along?*
Skincare Products you are currently using in this program: Please provide the names & strengths*
Have you had any reaction to any products in your new Skincare routine?*
If yes, what products?*
Does your skin feel dry, irritated or stinging with your current products?*
What areas do you feel are your most problematic?*
Is there anything else you would like us to know so that we can better help you achieve clear skin?*
Remember to send your photos to: Jean@TalkWithJean.com