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In order for us to recommend the right Peau Vive treatment
for your skin type, please fill out the form below.

Skin Type Analysis

Eye Colour:

Hair Colour:

Response to the Sun:

Skin Colour:

Pore Size:

Oily or Dry

Breakout:

Facial Lines

Redness

 

Personal and Environmental

Date of Birth

Diet:

Fitness Level:

Major Illness:

Stress Level:

Health:

Medication:

Sun Exposure:

Allergies:

 

Contact Information

Name*:

Phone Number*:

Fax Number:

E-mail Address*:

Contact Time:

*Required

Thank you for taking the time to fill out this form, one of
our trained aestheticians will review your answers and email your personal environmental protective analysis.

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