All virtual skincare analysis require time and attention to detail to create the best possible regimen for you! Please do not fill this out if you do not have any intentions of starting a regimen under the care of Cece

Photos:

Please send photos of your natural bare skin to Bycece@icloud.com with your name in the subject. Please take these photos in front of a window preferably not using the selfie camera for best quality. Please take one photo of your right side profile, one photo of your left side profile, and one from your front profile. Please send close up photos of any areas of concern, such as acne, scars, dark spots, texture etc.

Name *

First Name

Last Name

Email *

Shipping Address

Phone *

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Shipping or Pick Up?

Shipping

Pick Up

What is your main skincare goals?

Glowing Hydrated Skin (correct dry or dehydrated skin)

Rid Acne/Oily & Hyperpigmentation (acne prone skin with pigmented scaring)

Anti-Aging Prevention (preventing signs of aging)

Pre Mature Aging Correction (correcting signs of pre-mature aging)

Do you need to do Acne Bootcamp (severe acne) $400-$500

Yes

What is your skin type?

Oily (Oily skin is characterized by a greasy appearance. This skin type is prone to acne breakouts. Oily skin is the result of excess sebum production.)

Dry/Dehydrated (Dry skin is determined by flaky and rough texture. It can at times feel tight and cause irritation.)

Normal Skin (Normal skin is neither too oily nor too dry. It has balanced sebum production and good blood circulation.)

Sensitive Skin (If your skin flushes and breaks out with spicy food and adversely reacts to new products, you may have sensitive skin)

Water Intake per day:

Do you suffer from texture on your cheeks, forehead, or chin?

Does your diet include a moderate to high consumption of dairy? Or gluten?

Do you use an SPF daily? And do you need a new SPF?

Do you experience bouts of skin blotching, burning, or itching?

Additional Information (Optional)

What is your biggest concern to address foremost?

Do you use birth control? If yes, does it contain progesterone and estrogen? or just one or the other? (please google search your birth control for the answer)

What do you like about your skin?

What do you dislike about you skin?

What is your budget?

Starter Regimen (2-3 products) $200-$250

Morning + Night Routine (4-6 products) $300-$400

Am + Pm + At Home Treatments W/Cece's Guidance (6-10 Products) $400-$600

Would you like treatment options as well?

Yes

What is your instagram handle?

Thank you!