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Skin Condition (select all that applies) *

Do you have an allergy history?

Have you ever visited a dermatologist or plastic surgeon? *

Do you currently use skincare products as a daily regimen?

Any active acne breakout? Please check all that applies

Do you have any history of acne or periodic breakout?

Do you only experience breakout during or around your menstrual cycle?

Do you always have a pimple or some type of breakout?

Does your skin ever flake or feel tight and dry?

If you don’t wash your hair for a day, what would happen to your hair?

How noticeable are your pores?

Do you experience “flush or reddened” skin when eating spicy food, drinking alcohol, when angry, or when you go in the sun, etc?

Does your skin ever get flaky or itch?

If yes, is it seasonal or all the time?

Have you ever been diagnosed with Rosacea?

If yes, when was the diagnosis made?

Do you have difficulty healing from a cut or burn?

If yes, please explain

Have you ever had keloid scarring?

If yes, please explain

Please upload 3~5 clear photos of your face, or areas where you’d like to be treated

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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