Virtual Skin Analysis Intake Form

Terms and Conditions

By submitting this form, I understand that my data will be strictly confidential. The Holistic Skin Specialist does not sell, share, or resell information. I confirm that all information in this form is true and accurate, any information withheld can effect the overall results from the recommended skincare protocol. I confirm that if I withhold important information and complications happen, The Holistic Skin Specialist will not be liable. I release The Holistic Skin Specialist and hold harmless against any claims, expenses, damages, and liabilities.

By accepting a complimentary/free Virtual Skin Analysis, I grant The Holistic Skin Specialist permission to use my submitted photos, skin concerns, skin analysis, and recommended treatment protocol for marketing, educational, and promotional purposes across all platforms, including but not limited to the website, social media, email marketing, print materials, and advertisements. I understand that my name and other personally identifying information will not be shared without my separate written consent.