SKIN CONSULTATION

1. How many hours do you sleep on average each night? * Less than 4 hours 4 - 6 hours 6 - 8 hours More than 8 hours

2. How much water do you consume daily? * Less than 4 cups 4 - 8 cups 8 - 12 cups More than 12 cups

3. How often do you consume processed or sweet food (fast food, snacks, package food)? * Rarely Occasionally Frequently Always

4. Do you smoke / consume alcohol? * Smoke Alcohol Both Neither

5. How do you take care of your skin? (Checkbox) * Aesthetic treatments Facial treatments Skincare products I rarely take care of my skin Others

6. What skincare products are you currently using? (Checkbox) * None Cleanser Toner / mist Essence / serum Eye care Moisturizer/ cream Mask Facial oil Sun protection Others

7. What is your favorite skincare brand? (open ended) *

8. What are your skincare concern? (Checkbox) * Acne (blackheads / pimple) Broken capillary Chemical or sun damage Dark eye circle Dehydration Dull skin Eczema Excessive oil secretion Eye bag Pigmentation Pores Saggy skin Sensitive Warts/ milia seeds Wrinkles / fine lines Others

9. Do you have any of the following health or medical concerns? (Check box) * Allergies Thyroid issue High blood pressure Heart disease Pregnant Diabetes Pacemaker Cancer Others

10. I confirm that all the information I provided is true and that I have not withheld any details or made any false statements. I understand and agree that this information will be used to develop my personalized custom-blended skincare solution, provide follow-up services, and keep me informed about launches and promotions. *