RM_Stats

Part 1 of 3

Full Name^*

Email^*

Phone Number^*

What is your Instagram handle?^*

Please share your username, or write N/A if you don't have or are not interested.

What do you clean your face with?^*

Nothing
Bar of Soap
Facial Cleaner
Other

If cleanser, which do you prefer?^*

N/A
Creamy
Exfoliating
Suds
Other

Do you use a toner?^*

Do you use anti-aging serums or antioxidants?^*

If so, please specify which ones, and if none please write N/A.

Do you use bleaching creams or other products to help sunspots or pigments?^*

If so, please specify which ones, and if none please write N/A.

Do you use an eye cream?^*

Do you use a moisturizer?^*

Do you use a sunscreen in the morning?^*

If so, please specify which ones, and if none please write N/A.

Which type of sunscreen do you use?^*

N/A
Tinted
Untinted

Do you have sensitive skin or burn easily?^*

Do you have acne or does your skin turn red easily?^*

How would you describe your skin?^*

Normal
Dry
Oily
Combination
Other

Which of the following do you have?^*

N/A
Crepey Skin (flaky like crepe paper)
Deep Wrinkles
Fine Lines
Dark Circles
Brown Spots

Part 2 of 3

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All Alastin Products use the Proprietary TriHex Technology

What product clears skin damage, while signaling production of new collagen and elastin?^*

ALASTIN HydraTint Pro
ALASTIN Regenerating Skin Nectar
ALASTIN Restorative Skin Complex
Don't Know

Do you consent to receive discount to your inbox?^*

Part 3 of 3

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Please select all that apply.

How do you prefer to book your virtual consultation?^*

N/A
Call
Email
Text

Is there anything else you'd like to share pertaining to your skincare wants, needs or desires?^*

Please share anything additional we can prepare prior to your meeting.

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YOUR SKINCARE ANALYSIS

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