First Name *

Phone *

Email *

Q1: When you gaze in the mirror, what catches your eye first? *

A. Healthy, even skin + a chill, relaxed expression

B. A few fine lines or eyes that say, “I’ve been busy”

C. A little fog-dullness, uneven tone, or tightness

D. Lines, puffiness, and a “been through it” kind of look

Q2: How often do you feel the weight of stress? *

A. Rarely-my vibe stays mellow

B. Some days more than others

C. Most days, I’m wound a little tight

D. Nearly all the time-my body + my face both feel it

Q3: How’s your skin to the touch? *

A. Soft + hydrated like fresh morning dew

B. Occasionally a little dry or rough

C. Tight, sensitive, or craving moisture

D. Dull, papery, or quick to flare up

Q4: What’s your dream world look like at night? *

A. Deep, peaceful sleep ’til the sun peeks in

B. Mostly good, with a few bumps in the night

C. I’m up and down like the moon

D. Sleep? That’s a distant memory

Q5: What’s the trickiest part of self-care for you? *

A. Finding time for me

B. Letting my mind truly slow down

C. Getting my skin out of the dry + dull zone

D. Feeling like I’ve aged in fast-forward