Health Waiver
Please take a minute to fill in the following info
First Name
Last Name
Email
Phone Number
DO YOU SUFFER FROM ACNE?
Yes
No
DO YOU SUFFER FROM PSORIASIS, ECZEMA, SENSITIVE SKIN OR DRY SKIN?
Yes
No
DO YOU SUFFER FROM DARK SPOTS, UNEVENESS, OR HYPERPIGMENTATION?
Yes
No
DO YOU SUFFER FROM LOOSE SKIN, CELLULITE, OR WRINKLES?
Yes
No
DO YOU SUFFER FROM LOOSE SKIN, CELLULITE, OR WRINKLES?
Yes
No
DO YOU SUFFER FROM INGROWN HAIRS?
Yes
No
DO YOU HAVE AN IMBALANCED PH?
Yes
No
DO YOU TAKE TOPICAL MEDICATIONS? IF SO WHAT?
WHAT IS YOUR CURRENT SKIN CARE REGIMEN?
I AGREE THAT THE PRODUCTS ON THIS SITE ARE NOT BEING RECOMMENDED BY A DOCTOR. THESE PRODUCTS ARE ALL NATURAL AND HAVE LITTLE TO NO RISK OF IRRITATION. IF I HAVE AN ISSUE WITH MY SKIN I WILL REACH OUT FOR SUGGESTIONS.
Your Signature
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