Client Questionaire: Your Full Name Your Email Address Where do you live? City/town and suburb: (for recommendations) Can you tell me about your skin? How does your skin condition affect your personal and work life? Is there anything that your skin condition stops you from doing? On a scale of 1 to 10 how motivated are you to make changes to your diet and lifestyle in order to heal your skin? (1 being not motivated at all and 10 being highly motivated) Thinking about the motivational score you gave, can you tell me why you didn’t give it a lower score? What prevented you from giving it a higher score? When considering your current situation, on a scale of 1 to 10 how able do you feel to make changes to your diet and lifestyle in order to heal your skin? (1 being not able at all and 10 being highly able) Thinking about the score you gave, can you tell me why you didn’t give it a lower score? What prevented you from giving it a higher score? How would you like to proceed? I would like to partner with your Skin Health Coach and do a full skin healing programme. I understand that the initial cost will be $99 and will include completing an online consultation form and attending a 45 minute Zoom consultation with your qualified Beauty Therapist. I will receive a personalised diet, lifestyle and nutrition plan, specific supplement and skin care recommendations and access to book in for follow-up consultation (at an additional cost). I would like to work with a Therapist near me. Please provide me with a recommendation if there is one available in my area. I would just like product recommendations to get me started on my skin healing journey and understand this is not the total solution. I am not quite ready to go on this skin healing journey. Submit
