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Virtual Email
Skin Consultation

Transforming Skin,
Enhancing Lives.

Please allow 1-3 business days to receive skin consultation.

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Virtual Skin Consultation Includes:

  • A detailed and comprehensive skin analysis via email

  • Tailored product recommendations with step-by-step guidance

  • Skin care knowledge on your unique skincare conditions and goals (plus skincare ebooks)

  • Access to Skin Alchemy HI Client Progress Tracker

  • Ongoing support via email / text

  • Product discounts for select brands

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***Products purchased separately

Korean Facial

Virtual Consultation Form

Please fill out this form, and I will send you a treatment plan and home care regimen within 1-5 days!

Your Skin Concerns
Medical History | Do you have any of the following conditions? If yes, please select them:
Any known allergies?
Yes
No
Any recent surgery, including plastic surgery?
Yes
No

Female clients

Are you pregnant or trying to become pregnant?
No
Yes
Are you taking birth control pills?
No
Yes
Are you undergoing any hormone replacement therapy?
No
Yes

Your Lifestyle

What is your sun exposure?
Do you use sun protection (sunscreen, hats, protective clothing)?
No
Yes
Do you use tanning beds?
No
Yes
Do you smoke?
No
Yes
Do you drink more than 4 caffeinated beverages a day?
No
Yes
What is your alcohol consumption?
Your Skin Type:

Your Skin History

Have you ever had an allergic reaction to any of the following?
Are you currently using products containing any of the following ingredients?
How does your skin heal?
Fast
Slow
Scars
Pigments
Do you get bruises easily?
No
Yes
Have you received Botox, Restylane, or Collagen injections in the last 6 months?
No
Yes
Are you comfortable with your progress photos being posted on our social media or website?
Yes
No

I have read and completed this questionnaire truthfully. I understand that withholding information or providing inaccurate details about my medical history, allergies, medications, and skincare routines may lead to contraindications or adverse reactions to the treatments I undergo. I agree to inform the technician of any changes in the above information.

Todays Date
Month
Day
Year
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