Monday & Tuesday 9:00am – 5:00pm
Wednesday 9:00am – 7:00pm
Thursday & Friday 9:00am – 5:00pm
Saturday & Sunday Closed
1170 Dolphin st White Rock, BC, Canada V4B 4G8
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Today's Date:
First Name:
Address (street name):
City:
Zip/Postal Code:
Last Name:
Address (line 2):
State:
Phone:
Email:
Are you still breaking out? YesNo
Is your skin getting clearer? YesNoAlready Clear
How long have you been on your routine?
How many days per week have you skipped your serum or acne med?
Write out your morning and evening routines step by step.
What products, if any, are burning, stinging or itching?
Are you dry, peeling, flaky and/or red? YesNo
Additional comments or questions:
Take 5 photos of your skin and upload them below.
NOTE: Before uploading, please rename photos with last name, first name and angle. Ex: smith-mary-left45degrees.jpg
~ One from each side ~ One straight on ~ One from a 45 degree angle from each side ~ Do not use a flash
( Ctrl + Click to select multiple photos ) Send
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