Online Evaluation Form

Personal data

About your skin and acne

Since when have you had acne problems? *
Where does your acne appear? *
How would you describe your acne? *
Have you received treatments before? *
Do you have sensitive skin or have you had allergic reactions to products? *

Lifestyle and habits

How often do you eat fatty, dairy, or sugary foods? *
How often do you suffer from stress or lack of sleep? *

Goals and expectations

What is your main goal with this treatment? *
How committed are you to following a daily routine?

Attach photos

Click or drag a file to this area to upload.