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* 1. Is your skin?

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* 2. Is your skin?

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* 3. Age spots?

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* 4. Fine lines and wrinkles?

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* 5. Do you suffer from acne or big pores?

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* 6. Discoloration in skin tone? If so what?(age spots, sunspots, melanoma, eczema, etc.)

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* 7. Dark circles or puffiness under eyes?

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* 8. What do you like about your skin? (Insert text box below)

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* 9. What are your skin goals? (Insert text box below question)

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* 10. Please leave your first and last name and Instagram name. (insert text box below)

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