Skin Consultation Form

Let's start with you

Basic contact details so we can reach you before your appointment.

First name

Please enter your first name.

Last name

Please enter your last name.

Email address

Please enter a valid email.

Phone optional

Date of birth optional

How did you hear about us? optional

Your skin profile

Help us understand your skin so we can recommend the right treatments.

Skin type

DryTight, flaky, or dull

OilyShiny, enlarged pores

CombinationOily T-zone, dry cheeks

NormalMostly balanced

SensitiveReacts easily, redness

Please select your skin type.

Primary skin concern

Acne or breakoutsActive pimples, congestion, clogged pores

Anti-aging & firmnessFine lines, loss of elasticity

Dark marks & hyperpigmentationPost-acne marks, uneven tone

Dullness & glowLack of brightness, tired-looking skin

Redness & sensitivityReactive skin, flushing

DehydrationSkin feels thirsty or tight

Please select your primary concern.

Additional concerns check all that apply

How sensitive is your skin?

Very sensitiveReacts to most products

Somewhat sensitiveOccasional reactions

Not sensitiveCan use most products

Please select your sensitivity level.

Known allergies or sensitivities optional

Your current routine & goals

Tell us what you're working with and what you'd love to achieve.

Current skincare products optional

Do you use SPF daily?

Yes, every day

Sometimes

Not currently

Not sure

Have you had professional facials before?

Yes

No, first time

Recent skin procedures? past 3 months — optional

Medications affecting your skin? optional

What would you love your skin to look and feel like?

Please share your skin goals.

Anything else I should know? optional

✦

Thank you, friend.

Your consultation has been prepared. Use the button below to send it to Wendy — or save a copy for your records.

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