Please fill out this consultation form so we can send you the right products!
After we review your consultation form and look at the photos you email, we will customize a morning and evening skincare routine.  Products will be sent after we receive all your information and paid invoice!

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*
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 week?*
Skincare Products you are currently using: Please provide product names*
Medical History (check all that apply)*
Are you currently under a Dermatologist care?*
List any prescription medications you've been on with a Dermatologist *
Have you ever had any reaction to any products or anything you have put on your face?*
If yes, what products?*
Are you allergic to any of the following?*
If you checked "other", what allergies do you have?*
Do you smoke?*
Do you use fabric softener?*
Do you swim in a chlorinated pool?*
Do you work around chemicals, tars, oils, grease or inks?*
Do you work nights?*
Please check any procedure you've done in the past 6 months:*
Have you ever taken antibiotics for your acne? *
If Yes, Please list the dates*
Have you ever taken Birth Control for your acne?*
If yes, Please list the name of the birth control and the dates you've used it*
Have you ever taken Accutane (or other name brand of Accutane)?*
If yes, please list the dates you have taken accutane and the %*
Please check any of these medications that you've taken in the past 12 months*
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?