Email

Birthdate

How did you hear about Lisa Eddy

What would you like to change or improve anything about your soul/skin/self?

Do you have a tendency to flush or blush easily?

Please list morning regimen with brand names (and direct links) possible.

Please list evening regimen with brand names (and direct links) if possible.

Do you exfoliate and use masks? Which ones & how often?

Do you wear makeup?

Please list exact names with links, if possible.

Are you using any topical or internal Rx or non–Rx medication, or hormones?

What is your Occupation?

Do you work out?

Are you experiencing any hormonal changes? What symptoms are you experiencing. Please elaborate.

What % of your diet is made up of whole fresh fruits and vegetables?

Do you have digestion issues?

Daily Water Intake (in ounces):

Daily Caffeinated Beverages Intake

What do you stay up at night thinking about?

On a scale of 1-10, 10 being the most, how confident are you in your skin?

What would you do with your life if you had more confidence in yourself and didn't care what anyone else thought about it?

If you would wave a magic wand, what would your life look like?

What else would you like to improve?

How Satisfied are you in your everyday life and relationships?

Soul + Skin Assessment