Skincare Consult Interest Form

We'd love to learn more about your skin concerns and what you are looking to achieve in a skin care consult with our team! Let us know a bit more about your skin below.

Please note this is a skincare consultation with our skin specialist, Heather. This is NOT a consult for a service with Blair.

First Name *

Last Name *

Email *

Phone *

Date of Birth *

Street Address *

City *

State *

Zip Code *

Sex *

Male
Female

Do you prefer an in-person or virtual consultation? *

In person
Virtual

What are your main skin concerns? *

Acne
Overall anti-aging
Fine Lines & Wrinkles
Crepey Skin
Dark Spots
Melasma
Dullness
Large Pores
Clogged Pores
Redness
Other

What is your skin type? *

Oily
Normal
Dry
Combo
Sensitive

What products are you currently using? (please list all products) *

What does your ideal routine look like? Are you looking for: *

Just the essentials
Enhancing your current routine with the right products
I want it all - full routine recommendation please!

What are you hoping to achieve in a skin care consult? *

Have you ever used any Skin By Blair products in the past? *

Are you currently pregnant, looking to become pregnant, or nursing? *

Please upload a close-up, makeup-free photo of your face straight on, from the left side, and from the right side, referencing the example photo provided below for guidance.

Please upload a close-up, makeup-free photo of your face taken straight on. *

Choose file or drag here

Supported format: JPG, JPEG, PNG

Please upload a close-up, makeup-free photo of the left side of your face. *

Choose file or drag here

Supported format: JPG, JPEG, PNG

Please upload a close-up, makeup-free photo of the right side of your face. *

Choose file or drag here

Supported format: JPG, JPEG, PNG

Is there anything else you'd like for us to know about your skin?

How did you hear about this service? *

Thank you!

Thank you for submitting your skincare consultation inquiry! Our skin specialist will be in touch with you soon!

Have a great day!

Thank you!

Thank you for submitting your skincare consultation inquiry! Our skin specialist will be in touch with you soon!

Have a great day!

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