Julisis Wave

JULISIS Skin Analysis

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First Name*
Last Name*
Address*
ZIP*
City*
Phone
Email*
Country*
Age20-30    30-40    40-50    50-60    60+
Ethnic group?caucasian    asian    afro american    other
Eye color/ hair color?
/
Is your complexion light, medium or dark?light    medium    dark
Are you a sun lover? Or sun bed?a lot    sometimes    rarely    no
Appearance: Any large pores, tendency
to impurities, extremely dry or oily zones?
Do you have rosacea, expanded capillaries?
Any hyper pigmentation?
Are those peculiarities permanent or periodically?permanent    perodically
Meat consumption? a lot    medium    no
Vegetablesa lot    medium    no
Sweetsa lot    medium    no
Alcohola lot    medium    no
Do you have:hypo thyroid condition  hyper thyroid condition  no
Do you drink enough water?up to 3 liters a day    up to 2 liters a day    less then 1 liter a day
Are you smoking?yes    no
Are you doing sports? 2 x a week or more  min. 1 x a week  irregular  no
How many hours of sleep do you need to feel regenerated?
How many hours do you sleep an average?
How often do you clean your face and neck? When?
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