MEDICAL HISTORY FOR ONLINE CONSULTATION

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    MaleFemaleNon Binary/Other





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    Tummy Problems (reflux, heartburn, stomach ulcer)Constipation, DiarreaPain in bonesAlergies or asthmaVaricose VeinsHeadache or MigrainsDiabitis or Insuline ResistanceMuscular PainsHigh Blood PressureHypothirodismHeart ProblemsCancerHIVliquid retentionCoffee DrinkingSmokingControlled susbstances abusePhysical activity


    No


    Have a daily skin routineVisited a professionalUse sunscreen dailyEat Healthy


    Fried FoodJunk FoodGreasy FoodCanned FoodSausagesChocolateAvocadoMayonnaiseSaucesVegetablesFruits




    AcneExpression linesDark skin spotsPremature AgingDilated PoresGreasy SkinDry SkinScars




    SI (CON ROSTRO)SI (SIN ROSTRO)NO


    Tummy Problems (reflux, heartburn, stomach ulcer)Constipation, DiarreaPain in bonesAlergies or asthmaVaricose VeinsHeadache or MigrainsDiabitis or Insuline ResistanceMuscular PainsHigh Blood PressureHypothirodismHeart ProblemsCancerHIVliquid retentionCoffee DrinkingSmokingControlled susbstances abusePhysical activity


    No


    XSSMLXLXXL


    XSSMLXLXXL


    Weight LossHabits change, eating planIncrease Energy LevelsGreen Juice RecipesCelulitisHealty food recipes





    SI (CON ROSTRO)SI (SIN ROSTRO)NO