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Home
About Us
Treatment Guides
Personalized Skin Care
Packages
Professional Skin Care Treatments
Beauty Experts
Contact Us
Personal Info
My Skin
My Routine
My Lifestyle
Goals
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Step 1 - Personal Information
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Step 1 - Personal Information
Email address
Used to send your results & consultation link.
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Step 1 - Personal Information
Age Range
Under 18
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65+
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Step 1 - Personal Information
Please upload a clear photo of your face or the specific area of your skin you'd like us to review.
5 Pictures
📷
I agree to Eudermic's Privacy Policy & understand this is not medical advice.
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Step 2 - Primary Skin Concerns
Primary Skin Concerns
"Select up to three" - multi-select boxes
Acne/breakouts
Hyperpigmentation/dark spots
Redness/rosacea
Sensitivity/irritation
Dryness/dehydration
Oilliness
Enlarged Pores
Blackheads
Fine lines/wrinkles
Loss of firmness/elasticity
Scarring/texture irregularities
Thyroid Disorders
Autoimmune Disorders
Other
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Step 3 - Current Skin Profile
How would you describe your skin type?
Normal
Dry
Oily
Combination
Not sure
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Step 3 - Current Skin Profile
Fitzpatrick Skin Type?
Type I - Always burns, never tans
Type II - Usually burns, tans minimally
Type III - Sometimes burns, tans gradually
Type IV - Burns minimally, always tans
Type V - Rarely burns, tans profusely
Type VI - Never burns, deeply pigmented
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Step 3 - Current Skin Profile
How does your skin react to new products?
No issues
Occasional stinging
Often irritated
Not sure
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Step 3 - Current Skin Profile
Average daily sun exposure?
Minimal
1-2 hours
3-5 hours
6+ hours
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Step 3 - Current Skin Profile
How often do you wear SPF?
Every day
Only outdoors
Rarely
Never
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Step 4 - Current Routine & Product History
AM Routine (Products you use)
cleanser
serums
Moisturizer
SPF
Retinol Oil
Face Wash
Eye Cream
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Step 4 - Current Routine & Product History
PM Routine (Products you use)
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Step 4 - Current Routine & Product History
Any professional treatments in the past 6 months?
Peels
Microneedling
Lasers
Injectables
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Step 4 - Current Routine & Product History
Have you used retinoids, benzoyl peroxide, hydroquinone, or acids (AHA/BHA/PHA) in the last 4 weeks?
Yes
No
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Step 4 - Current Routine & Product History
Product(s) that irritated or didn't work for you
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Step 5 - Health & Lifestyle Snapshot
Prescription meds / topical RX currently used on skin
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Step 5 - Health & Lifestyle Snapshot
Food or ingredient allergies
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Step 5 - Health & Lifestyle Snapshot
Current stress level
1
2
3
4
5
6
7
8
9
10
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Step 5 - Health & Lifestyle Snapshot
Hormonal changes?
Are You Pregnant?
Yes
No
Breastfeeding
Yes
No
Menopausal
Yes
No
On Hormone Therapy
Yes
No
Experiencing Frequent Hormonal Changes
Yes
No
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Step 5 - Health & Lifestyle Snapshot
Average Sleep Per Night
4 hrs
4-6 hrs
6-8 hrs
8 hrs +
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Step 5 - Health & Lifestyle Snapshot
Daily water intake?
1 L
1-2 L
2-3 L
3 L+
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Step 6 - Goals & Expectations
What is your #1 skin goal right now?
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Step 6 - Goals & Expectations
Timeline preference
ASAP (event in 4–6 weeks)
6 Steady improvement over 3–6 months
Long-term maintenance
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Step 6 - Goals & Expectations
How committed are you to a routine?
1
2
3
4
5
6
7
8
9
10
forgetful
super consistent
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Step 6 - Goals & Expectations
What's your monthly skincare budget?
Under $50
$50–$100
$100–$200
$200+
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