Skincare Consult Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Birthday * MM DD YYYY What is your skin type? * What is your current skincare regimen? * Do you wear sunscreen everyday? * (If your answer is yes, what is your current sunscreen?) What is your sunscreen preference? * (Clear, tinted, matte, glowy/dewy?) Do you use retinol/tretinoin/retin-a? * Do you have any medical issues? * (ie pregnant, breast-feeding, history of autoimmune, etc) Do you take any daily medications or vitamins? * What are your skincare goals? * Have you had any aesthetic treatments in the past? If yes, please list whatt you have had done: * Do you have any allergies? * Thank you! The HaleStorm team will be in touch shortly.
