Basic Information
Skin Type
Description
Duration
Consultation
Area
Treatments
Full Name
Age
Gender
Number
Email
.
Basic
Information
Oily
Dry
Combination
Normal
Sensitive
Not Sure
Skin Issue Description
Acne/Pimples
Dryness
Redness or Inflammation
Dark Spots or Pigmentation
Wrinkles or Fine Lines
Itching or Irritation
Rashes
Other
Duration of the Issue
Less than a week
Less than
a week
1–3 months
More than 3 months
More than
3 months
Preferred Time for Consultation
Morning
Afternoon
Evening
Affected Area
Face
Neck
Arms
Legs
Full Body
Previous Treatments
yes
No
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