Application Form

We want to get to know you! Please complete the form below to we can get to know you and your skin challenges.

By submitting this application form, you are ready to make changes in your skin, you want to know more about the challenge and how you can win our Skin Challenger prize valued at $899!

Full Name *

Email

Phone

How old are you? *

under 25
26-35
36-45
46-55
55-69
70+

What are your main skin concerns? *

Dehydration
Redness/Sensitivity/Rosacea
Acne/Congestion
Aging/Fine Lines/Wrinkles
Pigmentation/Sun damage
Scarring
Other

What changes would you like to see in your skin? *

Send us three photos of your skin without makeup on. Front on, left and right please! (Hint! Natural indirect light in best) *

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

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Tell us what facial treatments you have tried in the past and what results you have had *

What skincare products are you currently using at home on a regular basis

Best times and day to visit for your treatments *

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Pure Fiji Dragonfruit Hydrating Body Mist

Pure Fiji Dragonfruit Hydrating Body Mist

The Skin Shammy

The Skin Shammy