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Is this your first facial?
What is your main concern with your skin?
Are you pregnant?
Are you currently under a physician's care for any current skin condition or any other problems?
Are you taking birth control pills? If ''Yes,'' What Type?
Are you currently taking any medications? If so, please list them
Are you presently using (or used in the past) Azlex, Differin, Renova, Retin-A, Tazarac, Glycolic or Alpha Hydroxy Acids? If ''Yes,'' when and for how long?
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