First Name
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Email
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Phone
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WHAT’S BLOCKING YOUR SKIN’S POTENTIAL?
Let’s Figure It Out
1: What is your primary skin concern?
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A. Fine lines and wrinkles
B. Acne scars or uneven texture
C. Dullness or lack of glow
D. Large pores or uneven skin tone
2: How would you describe your skin’s current condition?
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A. Starting to show signs of aging
B. Rough or bumpy from past or current breakouts
C. Tired and lackluster
D. Oily with visible pores
3: What’s your biggest frustration with your skincare routine?
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A. Products don’t seem to reduce aging signs
B. Nothing smooths out my skin’s texture
C. My skin still looks flat despite efforts
D. Can’t control oiliness or tone issues
4: What’s your goal for your skin in the next few months?
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A. Look younger and more refreshed
B. Achieve smoother, clearer skin
C. Restore a radiant, healthy glow
D. Minimize pores and even out tone
5: How do you feel about professional skin treatments?
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A. Excited to try something for anti-aging
B. Ready for a solution to fix scars
C. Open to treatments that boost glow
D. Eager for something to balance my skin