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Services
Schedule Appointment
Team
Policies
Referral Program
Acne Boot Camp
Body & Skin Treatments
Chemical Peels
Consultation
Eyebrow Services
Makeup Services
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Please fill our evaluation form:
Name
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First Name
Last Name
Email
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Subject
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Message
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Phone
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How did you hear about us?
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Please list all nutritional supplements you are consuming whether they are in powder, liquid or capsule form.
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Are you taking any prescription medication and are you currently under the care of a Dermatologist? If yes, please list all medications/doses and the contact information for your physician.
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Do you consume dairy/gluten/processed sugar? How often? Can you describe your typical day to day nutrition?
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What are your main skin concerns?
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Do you have have specific goals in mind with a hopeful time-frame?
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What best classifies your skin type?
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Dry / Dehydrated
Oily / Acne - prone
Combination (Mostly Oily)
Combination (Mostly Dry
Please describe your morning and evening skincare routine, in detail please. What products are you using on your skin in the morning and in the evening
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Do you wear SPF daily? Do you reapply every 2 hours?
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Do you do any weekly treatments on yourself at home for your skin? Any treatment masks/peels?
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How would you describe your stress level?
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Moderate
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Extremely High
Additional message (optional)
Photo upload
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By checking this box, you understand you will need to upload & send an unfiltered & no makeup face photo to: aestheticbeautybarllc@gmail.com.
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You will need to send an unfiltered photo of your face to our email: aestheticbeautybarllc@gmail.com