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First Name *

Last Name *

Email *

Phone Number *

Address

Skin Type

Normal-Smooth Skin, balance of oil and moisture, infrequent blemishes

Combination- Smooth skin, oily t-zone and dryness on outer edged of face

Oily- Large pores and shiny in appearance

Sensitive-redness and allergic reactions

Dry- Small pores/dull in appearance. Little or no oil or shine

What skin products do you typically use? What is your daily routine?

What kind of makeup do you normally wear? Please list products and brands

How often do you wear makeup?

Daily

Special Occasions

Never

What type of makeup look are you aiming for? Please be specific

Are you allergic to any makeup products or do you have any skin allergies?

Have you had a high fever/severe illness in the past two weeks?

What are your biggest concerns when it comes to makeup?

Date *

Signature *