Skin Assessment Form

skin goal

which skin goal is most important to you?

You’ll be able to pick additional goals next!

which skin goal is most important to you?

Clear Acne

Or other acne-related concerns, like acne marks and clogged pores

Treat rosacea

Including redness and inflamed bumps

Fight wrinkles

Or other anti-aging concerns, like dark spots and loss of firmness

Other

I would like to focus on other goal

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what other skin goals do you have?

We’re listening. Share multiple so we can select the best treatment for your unique needs. (Select all that apply)

what other skin goals do you have?

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how would you describe your acne?

Select the description that most closely matches your skin.

how would you describe your acne?

Mild

I get clogged pores or inflamed pimples on less than half my face.

Moderate

I get clogged pores or inflamed pimples on more than half my face.

Severe

I get inflamed pimples all over my face, or I get large, painful cysts.

No acne

I don’t typically get pimples and want to focus on other skin goals.

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what’s your skin type?

This helps our skincare professionals pick the right ingredients for your skin.

what’s your skin type?

File Upload

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how sensitive is your skin?

Let us know if your skin is easily irritated when using new products.

how sensitive is your skin?

My skin is easily irritated

My skin is rarely irritated

I don’t typically try new products

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what products do you use?

Understanding your routine helps us make personalized recommendations for your skin.

(Select all that apply)

what products do you use?

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what was your sex assigned at birth?

We ask because hormones play a big role behind the scenes in your skin.

what gender do you identify as?

Male

Female

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what gender do you identify as?

We support you, however you identify!

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Cisgender man (born and identify as a man)

Cisgender woman (born and identify as a woman)

Transgender

Gender nonbinary

Different identity

Prefer not to say

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are you pregnant or breastfeeding?

I’m pregnant

I’m breastfeeding

I’m trying to get pregnant

None of the above

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what ethnicity do you identify as?

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are you using any prescription or over-the-counter medications?

This includes birth control (any type), topical medications, and/or supplements.

Yes

No

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any medical conditions or surgeries?

Medical conditions can impact your skin and play a role in the treatments we recommend.

any medical conditions or surgeries?

Yes

No

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anything else you’d like to share?

We’re all ears.

Yes

No

What do you like to share?

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ready for your results?

First Name

Last Name

Phone

Email

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skin goal

which skin goal is most important to you?

You’ll be able to pick additional goals next!

Clear Acne

Treat rosacea

Fight wrinkles

Other

goals

what other skin goals do you have?

We’re listening. Share multiple so we can select the best treatment for your unique needs. (Select all that apply)

Clear acne

Boost firmness

Treat clogged pores

Improve skin texture

Fade dark spots

Treat rosacea

acne

how would you describe your acne?

Select the description that most closely matches your skin.

Mild

Moderate

Severe

No acne

skin type

what’s your skin type?

This helps our skincare professionals pick the right ingredients for your skin.

Very Dry

Often Dry

Combination

Often Oily

Very Oily

skin type

how sensitive is your skin?

Let us know if your skin is easily irritated when using new products.

products

what products do you use?

Understanding your routine helps us make personalized recommendations for your skin. (Select all that apply)

identity

what was your sex assigned at birth?

We ask because hormones play a big role behind the scenes in your skin.

identity

what gender do you identify as?

We support you, however you identify!

identity

are you pregnant or breastfeeding?

identity

what ethnicity do you identify as?

medical

are you using any prescription or over-the-counter medications?

medical

any medical conditions or surgeries?

Medical conditions can impact your skin and play a role in the treatments we recommend.

other

anything else you’d like to share?

almost done

ready for your results?

Understanding your routine helps us make personalized recommendations for your skin.

(Select all that apply)