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Advanced Nutrition Programme
Exuviance
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Heliocare
Medik8
Neostrata
Other Brands
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Condition
Acne
Anti-Aging
Dark Circles
Dry Skin
Hair Loss
Hyperpigmentation
Normal Skin
Oily Skin
Rosacea
Sensitive Skin
Sun Damage
Product Type
Anti-Aging Creams
Cleansers & Toners
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About you
Your concerns
Your skin goals
Other
1. Personal details:
Gender:
Male
Female
Age:
18-29
30-39
40-49
50-59
60 +
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2. Choose your skin type:
Very fair – burns instantly in the sun
Fair – blue eyes, burns easily, tans poorly
Fair but tans
Olive/Mediterranean – tans easily
Black
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3. How would you describe the overall condition of your skin?
Dry – skin feels tight and rough in texture, can be flaky and sometimes sore
Oily – skin feels more greasy, can look shiny, may suffer with some breakouts and open pores
Combination – greasy on the t-zone and dry on the cheeks
Normal – skin doesn’t feel overly dry or oily, feels comfortable
None of the above
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4. Do you experience any of the following concerns?
Dryness – tight, flaky, dull
Acne – breakouts, inflamed spots, redness, congestion/blackheads
Oily – open pores, shiny skin, congestion
Rosacea or redness – sensitivity, skin can feel sore and uncomfortable
Ageing – skin laxity, fine lines and wrinkles
Uneven skin tone – pigmentation, hyperpigmentation, skin damage
None of the above/other
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5. Please describe your daily skincare routine and your current skin care products you are using?
Morning:
Night:
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6. What are your top 3 skin concerns?
1. Please add your first concern below
2. Please add your second concern below
3. Please add your third concern below
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7. What are your skin care goals and what would you like to achieve?
For example - Firmer, Glowing, Minimised pores etc.
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8. How much do you spend on skin care products?
I don’t mind, quality is more important then price
I prefer to use mid priced products
I prefer to use low priced products
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9. More information:
Please enter any other information that you think we should know before analysing your answers. Example, if you are pregnant, have any allergies, any medical conditions, or recently undergone a cosmetic procedure.
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10. Upload an image: (optional)
Make up free, close up, natural daylight
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11. Contact details:
Your name:
Email address:
Contact number:
Address:
X