Ready to get your perfect skincare routine?

1

Full Name* This field is required.

First Name

Last Name

2

E-mail* This field is required.

example@example.com

3

Phone Number* This field is required.

Area Code

Phone Number

4

Are you over 18?* This field is required.

Yes

No

5

1. What are your top skin concerns? (Select all that apply)

Acne & Breakouts

Redness & Sensitivity

Fine Lines & Wrinkles

Dryness & Dehydration

Oily Skin

Hyperpigmentation / Dark Spots

Other (write below)

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If other write here:

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How would you describe your breakouts? (If you selected acne as a concern)

Mild (Occasional small spots)

Moderate (Consistent breakouts, some inflammation)

Severe (painful, cystic acne)

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3. What skincare products are you currently using?

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4. Do you have any known allergies or sensitivities? (If yes please write below)

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5. How would you describe your lifestyle & diet?

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6. What's your biggest skincare frustration right now?

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7. What's your ideal skin goal? (Select the closest to your goal)

Clear, acne-free skin

Smooth, even skin tone

Hydrated, glowing skin

Youthful, wrinkle-free skin

Calm & balanced (no redness/sensitivity)

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8. Upload photos of your skin (natural light, no makeup) * This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.0MB

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Thank you for completing your skin quiz! Keep an eye on your inbox- I'll personally review your results & send you my best recommendations through Get Harley!