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1. Name *
2. Age
3. Email address * I want to know about promotions, new supplies and news
4. Phone. *
5. Skin type *
dryfatcombinednormal
6. The main problem
pigmentationrosaceaacnesensitivityseborrheic dermatitisatopic dermatitispsoriasis
Do you have allergic reactions, if so, to which components? wrinklesblood network (rosacea)comedonesshellingoily shine on the skinpostacne
7. What products do you use in the morning and evening care (specify the exact name and brand of cosmetics)? *
8. What problem needs to be solved first? What effect would you like to get from the selected cosmetics? *
9. Do you need a specific tool?
skin cleansersmakeup removertonicserum
day creamnight creamI am interested in choosing a comprehensive care
10. Is there any ingredient / remedy you want to include in your care? *
11. Do you use the services of a beautician? If so, what procedures do you undergo? How often and when was the last procedure performed? Do you plan to continue the salon procedures? *
12. Are you registered with a dermatologist? If so, with what diagnosis and what treatment is prescribed? *
13. Are you taking any medications / supplements? If so, which ones? *
Are you pregnant? * YesNo
Are you currently in lactation? * YesNo
Are you undergoing cancer treatment? * YesNo
14. What amount do you expect? *
there is no set amountup to UAH 500from UAH 500 to UAH 1,000from UAH 1,000 to UAH 2,000from 2000 UAH and more
Additional Information
15. How did you find out about us?
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16. To find out the exact needs and problems of your skin, attach photos of skin fragments (nose, forehead, cheeks, chin), preferably in good quality and during the day, without makeup.
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