Alchemy Individualised Skin Care Products |
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Client Consultation Form - Private & Confidential
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| Name: | Address: |
| Tel.No: | |
| E-Mail: | Date of Order: |
| Product Required: | ................................................................. |
| Please indicate by circling appropriately within the following categories:- | |
| Nearest skin type/types: | |
| Normal • Oily • Combination • Dry • Sensitive • Mature | |
| Any skin problems: | |
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Acne • Blackheads • Whiteheads • Broken • Capillaries Rosacea • Hydrated/Puffy • Dehydrated • Eczema |
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| Nearest age group: | |
| 18-28 • 29-39 • 40-50 • 51-61 • 62+ • men - post men! | |
| Do you have any allergies? | |
| Nut • Wheat • Plant/herb/spice • Bee Stings • Other | |
| Please specify if Other: | ................................................................. |
| What kind of aromas do you like? | |
| Floral • Woody • Spicy • Citrus • Herby • Other | |
| Please specify if Other: | ................................................................. |
| N.B. Creams will also smell of honey as bees-wax is used as the emulsifier. | |
| Please read the list of Contraindications and Considerations and write overleaf any relevant information as it may effect my selection of essential oils etc: | |
| Please tick as appropriate: |
[ ] I have listed all relevant conditions overleaf [ ] I have no contraindications/considerations |
| Please Sign hereabouts! | ................................................................. |
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Pat Hodges, Alchemy, 32, Elderberry Lane, Christchurch, Dorset BH23 3RW |
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