If you have any skincare or product questions, Deborah DePiano is here to help.
Comments:
For skincare or product inquiries, please answer the following questions:
1. Your age range
under 19
19-25
26-35
36-45
46-59
60+
- SELECT -
2. Sex:
Male
Female
3. Are you pregnant or breast-feeding?
Yes
No
4. Do you smoke?
Yes
No
5. Have you undergone laser resurfacing in the last 3 months?
Yes
No
6.Which of the following best describes your skin?
Select
Somewhat oily in the T-zone but not all over
Undeniably oily all over, even in the cheek area
Noticeably dry all over
Noticeably dry and sensitive
Problem/blemished
Environmentally/sun damaged
7. How often do you have acne breakouts?
Select
Never
You have breakouts once in awhile
You are prone to breakouts at least once a month
You have persistent acne
8. Have you been diagnosed with any of the following conditions?
Rosacea with acne breakouts
Rosacea with very dry, sensitive skin
Keratosis Pilaris
Eczema
Periorial Dermatitis
Folliculitis
None of the above
9. Do you have allergies to any of the following?
Alpha or Beta-Hydroxy Acids
Hydroquinone
Benzoyl Peroxide
None of the above
10. Are you currently on any of the following medications?
Acne medications
Accutane
Retin-A
Differin
Azelex
Retin-A for Fine Lines
Renova
Metrogel/cream
Birth Control Pills
Hormone Replacement Therapy
None of the above
11. What, if any, additional results are you looking for?
Even out skin tone/texture
Fade dark spots
Control excess oiliness
Restore elasticity/firm skin
Diminish wrinkles and fine lines
Minimize pore size
Clear up blackheads
Increase hydration/reduce flakiness
Reduce eye puffiness
Control/reduce ingrown hair
Reduce acne scarring
12. Do you have facials?
Yes
No
13. If yes, how often?
Select
Once a year
Several times a year
Once a month
More than once a month
14. Do you wear sunscreen daily?
Yes
No
15. How often do you exercise?
Select
Frequently
Occasionally
Rarely to never
16.How much water do you drink?
Select
8 glasses/day
4 glasses/day
1 glass/day
17. Do you currently take vitamins?
Yes
No
18. How would you describe your overall level of stress?
Select
Low
Medium
High
How to contact you:
First Name
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Last Name
Phone
E-Mail
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(310) 289-7992
