Skin Consultation Test - Post

Pure 111 Skincare Consultation

Step 1 of 13

What is your first name?

What is your last name?

What is your email?

What is a phone number where we may call or text you with any questions?

Are you currently working with one of our providers?

Yes

Please include photos of your skin*

Accepted file types: jpg, jpeg, png, gif.

Natural lighting with no makeup, face forward, right side and left side.

My Age is Between:(Required)

24 and under

25-34

35-49

50 and over

I want to focus on treating and preventing signs of aging on my skin.(Required)

Yes. My highest priority is to treat and prevent signs of aging, such as wrinkles and fine lines.

Yes. I am concerned with signs of aging; however, I have other top-priority skin concerns I would like to address first.

No. I am not concerned with signs of aging.

Comments

I struggle with:(Required)

Dull skin, acne scars, and visible pores. I want products to brighten skin, treat acne scars and shrink my pores.

Uneven pigmentation, sun damage and overall skin discoloration. I want products to treat my uneven skin tone.

Neither of these options relates to my skin type.

Comments

I have oily, blemish-prone skin.(Required)

Yes. I have very oily skin and break out often.

Somewhat. My skin feels oily at times and I have acne spots.

No. I don’t have oily or blemish-prone skin.

Comments

My skin often:(Required)

Flushes red. I want products to treat my sensitive, redness-prone skin.

Feels incredibly Dry. I want products to replenish and hydrate my skin.

My skin is not redness-prone and does not feel incredibly dry.

Comments

At birth, my sex was assigned:(Required)

Male

Female

I do not want my results to be impacted by my sex. I am ready to start my journey towards better skin.

Comments

I am pregnant, nursing or postpartum:(Required)

Yes, I am pregnant, nursing or postpartum. I am looking for safe, effective skincare products to brighten my skin.

No, I am not pregnant, nursing or postpartum.

Comments

Are you currently taking any oral prescriptions or using any topical prescriptions for your skin?(Required)

Yes

If yes, please list the name and percentage of the prescription and how you are currently using it.

Tell us anything you’d like us to know about your skin:

I am ready to invest in healthy skin and want to receive 20% off of my entire first order of Skin 111!(Required)

Absolutely! I want to achieve my most optimal skin!

Definitely! I can’t miss out on this fantastic discount.

Yes! My journey begins toward happier, healthy skin.

Pure 111 Skincare Consultation

Step 1 of 13

What is your first name?

What is your last name?

What is your email?

What is a phone number where we may call or text you with any questions?

Are you currently working with one of our providers?

Yes

Please include photos of your skin*

Accepted file types: jpg, jpeg, png, gif.

Natural lighting with no makeup, face forward, right side and left side.

My Age is Between:(Required)

24 and under

25-34

35-49

50 and over

I want to focus on treating and preventing signs of aging on my skin.(Required)

Yes. My highest priority is to treat and prevent signs of aging, such as wrinkles and fine lines.

Yes. I am concerned with signs of aging; however, I have other top-priority skin concerns I would like to address first.

No. I am not concerned with signs of aging.

Comments

I struggle with:(Required)

Dull skin, acne scars, and visible pores. I want products to brighten skin, treat acne scars and shrink my pores.

Uneven pigmentation, sun damage and overall skin discoloration. I want products to treat my uneven skin tone.

Neither of these options relates to my skin type.

Comments

I have oily, blemish-prone skin.(Required)

Yes. I have very oily skin and break out often.

Somewhat. My skin feels oily at times and I have acne spots.

No. I don’t have oily or blemish-prone skin.

Comments

My skin often:(Required)

Flushes red. I want products to treat my sensitive, redness-prone skin.

Feels incredibly Dry. I want products to replenish and hydrate my skin.

My skin is not redness-prone and does not feel incredibly dry.

Comments

At birth, my sex was assigned:(Required)

Male

Female

I do not want my results to be impacted by my sex. I am ready to start my journey towards better skin.

Comments

I am pregnant, nursing or postpartum:(Required)

Yes, I am pregnant, nursing or postpartum. I am looking for safe, effective skincare products to brighten my skin.

No, I am not pregnant, nursing or postpartum.

Comments

Are you currently taking any oral prescriptions or using any topical prescriptions for your skin?(Required)

Yes

If yes, please list the name and percentage of the prescription and how you are currently using it.

Tell us anything you’d like us to know about your skin:

I am ready to invest in healthy skin and want to receive 20% off of my entire first order of Skin 111!(Required)

Absolutely! I want to achieve my most optimal skin!

Definitely! I can’t miss out on this fantastic discount.

Yes! My journey begins toward happier, healthy skin.

Skin Consultation Test – Post

Pure 111 Skincare Consultation

Pure 111 Skincare Consultation

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