Health Assessment

1. How would you describe your diet?*
2. How much water do you drink per day?*
3. How often do you exercise?*
4. Do you smoke?*
5. How would you rate your physical condition?*

Wellness History

1. Do you suffer from any of the following?*
2. Have you had any operations or injuries recently?
3. Are you allergic to, or do you have any sensitivity towards certain foods, medicines or other substances?
4. Are you pregnant or nursing?
5. Do you wear contact lenses?

Skin Care

1. How would you describe your skin type?
2. Are you currently concerned with any of the following?


1. Have you traveled to a country with a high number of COVID-19 cases?*
2. Have you been exposed to anyone with a lab-confirmed positive test for COVID-19, or anyone who is currently under mandatory quarantine for possible COVID-19 exposure?*
3. Do you currently have, or recently had, a cough, shortness of breath, headache, GI symptoms such as diarrhea OR a fever of 38 degrees or more?*