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FGM IN-DEPTH CONSULTATION
FGM IN-DEPTH CONSULTATION
This form is for US residents only. All details are emailed upon completion of this form.
37Questions
  • 1
    Hi! I'm Hadiyah. And you are?
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  • 2
    Gmail is preferred for Hangouts but whichever email you check most frequently is fine.
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  • 3
    Please use your preferred shipping address
    United States
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  • 4
    We follow our clients back!
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  • 5
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  • 6
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  • 7
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  • 8
    Please upload at least three bare face selfies of the FRONT, RIGHT SIDE, and LEFT SIDE of your face. You can also include additional closeups of problem areas if you feel they are necessary. These photos should be well-lit with the light source being in front of your face, not behind or to the side. And the background should not have any distractions. A plain wall is best.
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    Select files to upload
    Max. file size: 10.6MB
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  • 9
    Please choose just ONE option from below
    • Acne
    • Acne Scarring (boxcar, ice pick, rolling)
    • Aging (fine lines/wrinkles)
    • Dark Circles/Under-eye bags
    • Dryness
    • Hyperpigmentation from old scars
    • Oiliness
    • Redness
    • Sensitivity
    • Texture
    • Uneven skin tone
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  • 10
    What are you hoping to achieve by working with an esthetician?
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  • 11
    Please list as AM and PM. Feel free to be as detailed as possible. Be sure to include your: cleanser, toner, serum(s), moisturizer(s), sunscreen, occlusive(s), masque(s), exfoliant(s), eye products, spot treatments, and anything else you may be putting on your face on a daily or weekly basis. NOTE: please indicate how long you've been using each product (i.e. 3 months, 2 weeks, etc.) EXAMPLE: AM Fairy Glow Mother Magic Milk Cleanser (6 months) Fairy Glow Mother Hydra Cadabra Toner (4 months) First Aid Beauty Ultra Repair Hydrating Serum (6 months) Fairy Glow Mother Glow Mojo Moisturizer (6 months) Flesh Beauty Sunscreen (3 months) PM Fairy Glow Mother Magic Milk Cleanser Neostrata Clarify Cleanser (1 year) Fairy Glow Mother Hydra Cadabra Toner Fairy Glow Mother Majestic No. 8 Serum (6 months)--only use Tues and Thurs A313 Treatment (1 year)--only use Sun and Weds Aquaphor (since birth)--I do not use this on nights I use A313
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  • 12
    Sensations include tingling, "stingling", stinging, heat, itchiness, coolness, burning, etc.
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  • 13
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  • 15
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  • 16
    Feel free to provide as much detail as you feel necessary.
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  • 17
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  • 18
    Yes, birth control counts.
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  • 19
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  • 20
    Please check yes if you have any autoimmune/respiratory disorders, systemic diseases, or anything that requires you to be under a doctor's supervision.
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  • 21
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  • 22
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  • 23
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  • 24
    Please select all that apply
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  • 25
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  • 26
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  • 27
    Please provide a link to this diet's description if it is readily available on the internet
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  • 28
    Vegan/Vegetarian/Pescatarian/No Red Meats, etc.
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  • 29
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  • 30
    Any workout shakes, immune booster "shots", etc. count
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  • 31
    Cigarettes, marijuana, or otherwise
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  • 32
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  • 33
    If you have an IUD, please answer yes
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  • 34
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  • 35
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  • 36
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  • 37
    Please check YES below to submit this form
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