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Skincare Consultation

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Name

Email Address

Phone Number

What are your top skin priorities (tick all that apply to you):

Lines and wrinkles

Loss of firmness

Uneven skin tone/pigmentation irregularities

Excess Oil

Blemishes (hormonal or regular)

Dry, flaky skin

Rough texture

Lack of radiance

Sensitivity

Preventing Ageing

Other - please specify

Please tick below all products that you currently use in your skincare routine:

Cleanser

Toner

Acids/Peels

Exfoliator

Mask

Serum

Day Moisturiser

Sunscreen

Night Moisturiser

Vitamin A

Eye Serum

Eye Cream

What skin treatments do you regularly have:

Facials

Chemical Peels

Microdermabrasion

Laser treatments

IPL

Injectables

Radio Frequency

Other

What skincare brands do you currently use?

Please give details on any other information that you feel will help maximise our time together:

New Field:

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Sacha’s Beauty, 1 Southcote Parade,
Reading, RG30 3DT

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