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Name
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Last
Email
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What option best describes your skin (use drop down)
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Mature/Deep Wrinkles
Mature/Ageing/Fine lines
Dry/dehydrated
Sensitive/Rosacea
Problematic Acne
Oily
Combination (oily T Zone)
Sun Damaged/weathered
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Do any of the following apply to you? Give details below
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Medical conditions
Allergies
Medication
Vegan
Poor sleeper
Menopausal
Smoker
Alcohol/drug use
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Tell me about your diet here
Good Healthy Mixed Diet
Takeaways/dining out 1-2 per week
Everything Home Cooked
Sweet tooth
Processed food/ready meals regularly
click all that apply
Rate your stress levels
Selected Value:
0
slide the bar to select your level of stress. 0-3 =low – You’re fairly relaxed most of the time 4-6 = moderate – Your feathers do get ruffled but you take it all in your stride 7-8 = high – You worry a lot and hold onto stress. Stress is affecting other parts of your life and sleep. You may be taking medication to combat stress or sleep loss. 10 = high – You feel your stress is out of control and you always feel stressed.
How much water do you drink per day
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2 litres or more
About a litre
Mainly tea and coffee
Fizzy drinks/Juice
select the option which best describes your fluid intake
Tell me about your current Skincare Routine
Soap & water
All the gear but no idea
I have been using cleanser, toner and moisuriser forever
I am clueless and need step by step help
Any additional information in the box below
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