Long Distance Check In

Please submit this form every two weeks. We will email you any changes you need to make to your current regimen.

  • Your Personal Information:

  • MORNING ROUTINE

  • CLEANSER

  • Acne Wash

  • Acne Scrub

  • Silica Scrub

  • Sensitive Skin Cl. Gel

  • TONER

  • Salicylic Toner

  • Glycolic Toner

  • Mandelic 3%

  • Soothing Hydrating Toner

  • Prime pH Toner

  • SERUM

  • Salicylic 7%

  • Glycolic 5%

  • Glycolic 10%

  • Vitamin A Pro 1

  • Vitamin A Pro 2

  • Vitamin A Pro 3

  • Vitamin A Pro Lightener

  • Skintinu Lightening Gel

  • Mandelic 8% Light

  • Mandelic 8%

  • Mandelic 15%

  • Lactobase A

  • HYDRATOR

  • Hydrating Emulsion

  • Oil-Free Emulsion

  • ACNE MED (a.m. routine)

  • 2.5%

  • 5%

  • 10%

  • 5% with Sulfur

  • 10% with Sulfur

  • A02 Cream

  • MOISTURIZER/SPF

  • Oil Free SPF 30

  • Micro TZ

  • SPF for Acne Prone Skin

  • Skintinu SPF 30

  • EVENING ROUTINE

  • CLEANSER

  • Acne Wash

  • Acne Scrub

  • Silica Scrub

  • Sensitive Skin Cl. Gel

  • TONER

  • Salicylic Toner

  • Glycolic Toner

  • Mandelic 3%

  • Soothing Hydrating Toner

  • Prime pH Toner

  • SERUM

  • Salicylic 7%

  • Glycolic 5%

  • Glycolic 10%

  • Vitamin Pro A 1

  • Vitamin A Pro 2

  • Vitamin A Pro 3

  • Vitamin A Pro Lightener

  • Skintinu Lightening Gel

  • Mandelic 8% Light

  • Mandelic 8%

  • Mandelic 15%

  • Lactobase A

  • HYDRATOR

  • Hydrating Emulsion

  • Oil Free Emulsion

  • ACNE MED

  • 2.5%

  • 5%

  • 10%

  • 5% with Sulfur

  • 10% with Sulfur

  • A02 Cream

  • MOISTURIZER

  • Cranberry Cream

  • Ultra Hyaluronic

  • Are you currently experiencing any of the following skin conditions:

  • Other Things We Need To Know

  • UPLOAD PHOTOS

  • Take five digital photos of your skin and upload them below after filling out the check-in form.

    NOTE: Before uploading, please rename photos with last name, first name, and side.
    (Ex. lennon-john-left45degrees.jpg)

    Instructions for taking photos
    - One from each side    
    - One straight on    
    - One from a 45 degree angle from each side    
    - Do not use a flash    
    - If available, use a macro setting

  • Reminders:
    1. Don’t wait for us to contact you – if your skin is getting too dry and/or irritated contact us immediately. Not doing so could impede your progress

    2. Send us photos no less than every month – we really need to see your skin!!

    3. We need to know where you are with your home-care every two weeks. Ultimately, we want to strengthen your routine every two weeks so your skin will clear more quickly.

    4. We will need to know all of the above information about your routine.

  • Thank you for completing your check in. Please wait after pressing submit to allow your browser time to process this form. Thank you!

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