Formulario Facial / Corporal

Have you ever suffered, or actually suffers from any of the next listed diseases, problems or habits, related to nutrition
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

Do you consume any prescribed medicine?
SíNo

Which of the next actions you oftenly make?
Have a daily skin routineVisited a professionalUse sunscreen dailyEat Healthy

Which of next foods do you prefer?
Fried FoodJunk FoodGreasy FoodCanned FoodProcessed Meats (sausages, bacon, etc)ChocolateAvocadoMayonnaiseSaucesVegetablesFruits

Skin problems that worry you
AcneExpression linesDark skin spotsPremature AgingDilated PoresGreasy SkinDry SkinScars

Send us a Face Picture, frontal part, without flash or make up

Send us a Face Picture, right part, without flash or make up

Send us a Face Picture, left part, without flash or make up

Have you ever suffered, or actually suffers from any of the next listed diseases, problems or habits, related to nutrition
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

Do you consume any prescribed medicine?
SíNo

Weight (in Pounds)

Height (in feet)

Shirt/Top Size
XSSMLXLXXL

Pants Size
X SSMLXLXXL

Reason(s) for consultation
Weight LossHabits change, eating planIncrease Energy LevelsDetox recipesCelulitisHealty food recipes

Frontal Full Frontal Body Picture, with extended arms (no face)

Back Full Body Picture, with extended arms (no face)

Left Full Body Picture, with extended arms (no face)

Right Full Body Picture, with extended arms (no face)