Skin @ Home | Main Street Beauty | Wichita, Kansas

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SKIN @ HOME

NOW YOU CAN ENJOY ALL THE BENEFITS OF A CUSTOMIZED FACIAL IN THE COMFORT OF YOUR OWN HOME. KITS INCLUDE EVERYTHING NEEDED TO COMPLETE ONE FACIAL AND IS HAND SELECTED BY LICENSED ESTHETICIANS TO MEET YOUR SPECIFIC SKIN TYPE, CONCERNS, AND GOALS.

PLEASE VISIT OUR ONLINE STORE TO PURCHASE A KIT THEN

RETURN HERE TO COMPLETE THE FOLLOWING QUESTIONS.

CHECK ALL BOXES THAT APPLY.

WHAT IS YOUR SKIN TYPE? * Required

OILY

NORMAL

DRY

SENSITIVE

MATURE

ACNEIC

ARE YOU CURRENTLY USING EXFOLIATING PRODUCTS AT HOME? * Required

RETINOL / RETIN A

SCRUBS

GLYCOLIC ACID

CHEMICAL PEEL OR MICRODERMABRASION WITHIN LAST MONTH

OTHER EXFOLIATING PRODUCT

NO EXFOLIATING PRODUCTS

WHAT ARE YOUR SKIN CONCERNS? * Required

BRIGHTEN OVERALL TONE

FIRM SKIN AND TREAT WRINKLES

TREAT BREAKOUTS

INCREASE HYDRATION

SMOOTH UNEVEN TEXTURE

CALM IRRITATION / REDNESS

DO YOU HAVE ANY OF THE FOLLOWING MEDICAL HISTORY? * Required

CURRENTLY PREGNANT OR LACTATING

CHEMOTHERAPY WITHIN LAST 2 YEARS

ACCUTANE WITHIN THE LAST 2 YEARS

EXCESSIVE SUN EXPOSURE

AUTOIMMUNE DISEASE

OTHER MEDICAL CONCERN

NO MEDICAL CONCERNS

I AGREE TO TERMS AND CONDITIONS. BY CLICKING "I AGREE", I HEREBY RELEASE MAIN STREET BEAUTY SUITES, LLC FROM ANY LIABILITY OF MISUSE OF PRODUCT OR ADVERSE SKIN REACTIONS. ALTHOUGH RARE, ANY ADVERSE REACTION MUST BE REPORTED WITHIN 48 HOURS.

THANK YOU FOR SUBMITTING!

MAINSTREETWICHITA@GMAIL.COM

301 NORTH MAIN STREET, SUITE 125, WICHITA, KS 67202

316-796-5888

© 2019 BY MAIN STREET BEAUTY SUITES, LLC.

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