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Full name *

Date of birth *

Email address *

Where are you based?

How did you hear about us?

Have you had a skin or hair consultation before?

Yes No

Which best represents your skin tone? *

Type I Very fair, always burns, never tans Type II Fair, burns easily, tans minimally Type III Medium, sometimes burns, gradually tans Type IV Olive/moderate brown, rarely burns Type V Brown, very rarely burns Type VI Deep brown, never burns

How does your skin feel by midday? *

How does your skin react to new products?

Breaks out easily Becomes red Darkens in patches Generally fine Not sure

Do you experience sensitivity or reactions to fragrances, certain ingredients, or product types?

Which of the above is your primary concern right now? *

This list updates based on your selections above.

Do you also have hair or scalp concerns you'd like to address?

Yes No

How long have you been experiencing acne?

Under 6 months 6–12 months 1–3 years More than 3 years

Where does it mainly appear? (select all that apply)

What does your acne mostly look like?

Have you tried any prescription treatments before? (select all that apply)

Topical antibiotics Retinoids Oral antibiotics The pill Spironolactone Roaccutane / Isotretinoin None

Do you notice your acne worsens around your period?

Yes No Not applicable

Have you been diagnosed with PCOS?

Yes No Not sure

When did you first notice pigmentation concerns?

Recently Years ago After pregnancy After starting/stopping contraception After a skin injury or spot

Does it worsen in summer / with sun exposure?

Yes No Not sure

Have you used any skin lightening or brightening products? If yes, which ones?

This is important for your safety — please include any products bought online or from beauty stores.

Have you experienced any reactions or worsening after using brightening products?

Are you currently using SPF daily?

Yes, always Sometimes Rarely No

What SPF product do you use?

If you avoid SPF due to white cast or texture, let us know — we can recommend better options.

Primary hair concern (select all that apply)

Hair type

3ALoose curls, S-shaped 3BSpringy ringlets 3CTight corkscrews 4ATight coils, S-pattern 4BZ-shaped, densely packed 4CTight coils, least defined

Current hair practices (select all that apply)

How long have you noticed hair loss or thinning?

Under 6 months 6–12 months 1–3 years More than 3 years Not applicable

Is the loss all over, or in specific areas?

Any diagnosed conditions? (select all that apply)

Alopecia areata CCCA (Central centrifugal cicatricial alopecia) Traction alopecia Seborrheic dermatitis None Not sure

Are you currently pregnant, breastfeeding, or planning pregnancy?

Currently pregnant Currently breastfeeding Planning pregnancy No

This is critical for treatment safety — some treatments are contraindicated during pregnancy.

Have you had any blood tests for hair loss? (select all that apply)

Iron / ferritin Thyroid Hormone panel None

Any recent significant stressors, illness, or major life events in the last 6–12 months?

Stress-related hair loss (telogen effluvium) is very common and often underdiagnosed.

Are you currently pregnant or breastfeeding?

Yes — pregnant Yes — breastfeeding No

Are you planning to become pregnant in the next 6 months?

Yes No

Do you have any diagnosed medical conditions? (select all that apply)

Other conditions (please specify)

Are you currently taking any medications, including contraception?

Do you have any known allergies to medications or skincare ingredients?

Have you had any allergic reactions or adverse effects from skincare products before?

Walk us through your current morning skincare routine

Walk us through your evening routine

Approximate monthly skincare budget

Under ₦15,000 ₦15,000 – ₦30,000 ₦30,000 – ₦50,000 ₦50,000 – ₦75,000 ₦75,000+

Where do you currently buy your skincare? (select all that apply)

Pharmacy Beauty store Online Specialist Black beauty retailers A mix of places

Have you tried any prescription skincare before? (select all that apply)

What does good skin look like to you?

What's the one thing you most want to change in the next 3 months? *

How consistent are you with skincare routines?

Very consistent Fairly consistent Struggle to maintain routines

Are you comfortable with a routine that takes more than 5 minutes morning and evening?

Yes, happy to invest the time Prefer something quick Depends on the results

Are you open to prescription treatments if recommended?

Yes No Open to learning more

Thank you!

Your skin care questionnaire has been submitted successfully, .
Our team will review your responses and get back to you with personalised recommendations.

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Let's get to know your skin

About You

Your Skin Type & Tone

Primary Skin Concerns

Acne Deep Dive

Hyperpigmentation Deep Dive

Hair & Scalp

Medical History & Safety

Current Routine

Goals & Expectations

Consent & Data

Thank you!

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Votre panier est vide

Let's get to know your skin

About You

Your Skin Type & Tone

Primary Skin Concerns

Acne Deep Dive

Hyperpigmentation Deep Dive

Hair & Scalp

Medical History & Safety

Current Routine

Goals & Expectations

Consent & Data

Thank you!