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PERSONALIZED SKIN ANALYSIS

Simply answer the questions below and Marc Edward will personally evaluate your confidential answers and respond with recommendations for the most effective product treatment plan for your skin concerns. Please provide us with answers to all the questions listed below so we can make the best possible recommendations. Your information is kept completely confidential and will never be sold or traded. This is Marc Edward Skincare's Privacy Policy.

 

* = required information

 
Contact Information *
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip Code:*
Your Email Address:*
What is the best number to reach you?*    
How would you prefer to receive your product recommendation results from a Marc Edward Skincare? (Note: Speaking with Marc is always recommended to ensure the most accurate recommendation possible. Please feel free to call us at (213) 705-8899.
*
Skin Health Information
1. Birthdate (mm/dd/yyyy): *
/ /
2. Your Sex is: *
3. Do you smoke? Yes No
4. Do You Have Allergies to Any Of The Following? (Check all that apply)
Aspirin Hydroquinone Salicylic Acid
Retin-A Hydrogen Peroxide Beta Hydroxyacids
Benzoyl Peroxide  
No allergies to any of the above

5. 

Are you currently using any antioxidant supplements?

Yes No

 

Are you currently using any Retin-A?

 Yes No

 

Are you currently using any Acutane?

 Yes No
6. Do you have any special skin problems? (Check all that apply)
I have environmentally damaged skin
I have occasional Acne
I have deep cystic Acne
I have dry skin with Acne breakouts
I have dehydrated skin
I have combination skin, dry in some places, oily in the T zone
I have oily skin all over my face
I have lines and wrinkles from natural aging
I have no special skin problems
Other:
7. What type of skin do you have?
8. What product line are you currently using?
9. What results are you looking for? (Check all that apply)
Clear up Acne eruptions
Decrease oiliness of skin
Lighten skin complexion or hyper pigmentation areas
Smooth Skin Texture
Diminish wrinkles and fine lines
Post-facial procedure or surgery skin care
Hydration
10. What do you like least about your facial skin?
 
11. I am interested in a professional facial treatment with Marc:
Yes No
 
BY SUBMITTING THIS FORM I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE FOLLOWING: This questionnaire submitted online cannot substitute for the completeness of an in-person consultation with licensed professional skin care estheticians or doctors.Marc Edward Skincare will analyze your skin type and suggest products solely on the completeness and accuracy of the information provided by you. This is not an automated generated response to your inquiry. This is a personalized E-Mail response from Marc Edward Skincare within 3-5 business days of sending your inquiry. If you require an immediate response, please call (213) 705-8899 Monday-Friday between 9 AM and 5:30 PM PST and we will be happy to assist you.
 
   

 
 

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