Questionnaire for individual care

    1. Name *

    2. Age

    3. Email address *

    4. Phone. *

    5. Skin type *

    6. The main problem

    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?

    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? *

    Are you currently in lactation? *

    Are you undergoing cancer treatment? *

    14. What amount do you expect? *

    Additional Information

    15. How did you find out about us?

    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.