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First name
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Last name
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Email
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What is your primary skin concern?
Fine lines or wrinkles
Acne or blemishes
Dryness or dehydration
Redness or sensitivity
Hyperpigmentation or dark spots
How would you describe your skin type?
Oily
Dry
Combination
Sensitive
What result are you hoping to achieve?
Clear and smooth skin
Hydrated and radiant skin
Reduced signs of aging
Even skin tone
Calmer, less irritated skin
Have you had any professional skincare treatments before?
Yes, regularly
A few times
Never
How much time can you dedicate to skincare each day?
5 minutes or less
10–15 minutes
20 minutes or more
How do you prefer your treatments?
Gentle and soothing
Intense and results-driven
Relaxing and pampering
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