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Name:
Surnames:
Address:
E-mail:
Birthday:
Post Code (C.P.):
City / Town:

Province:
Profession:
Telephone nº:


Nerve problems: Yes    No  
Do you sleep well? Yes No  
How long do you sleep?  
Do you smoke? Yes No  
Your nourishment is: Good   Regular    Bad
How much water do you drink everyday?     
Constipation:  
Suffered diseases:

Do you take medicine?


-- Skin diagnostic --
   Does your skin itch? Yes  No
   Does your eyebrow desquamate? Yes No
   Does the corner of your mouth desquamate? Yes No
   Do you have dirty pores in your nose? Yes No
   Do you have dirty pores in your chin? Yes No
   Do you have wrinkles in your eye contour? Yes No
   Do you have wrinkles in the corner of your mouth? Yes No
   Does your skin tend to suffer from rashing? Yes No
   Do you have dryness in your cheeks? Yes No
   Do you suffer from acne or do you have acne scars? Yes No
   Do you have skin dull color brilliant aspect? Yes No
   Do you have rough skin and without any kind of sheen? Yes No
   Do you have sheen skin in nose and chin? Yes No
   Do you have normal or dry cheeks? Yes No
   Do you have wrinkles in all your face? Yes No
   Do you have wrinkles in your neck? Yes No
   How often do you shave?
   Do you suffer from rashing after shaving?                Yes    No
   If there are other observations no indicated above but you consider that they are important for us to know, please indicate.

    

 

   Cabelmar has at your service a special page where you can consult or ask us any doubt you may have. Please do not hesitate to contact us for further information. Our address and timetable are:

   Address:
        Cosmética Cabelmar
        C/ Valencia, 4
        Tf.: 902 190 478
        03150 - Dolores (Alicante)

   Timetable:
        For Monday to Friday
        Mornings: From 10.00 a.m. to 14.00 p.m.
        Evenings: From 16.00 p.m. to 20.00 p.m.

   Please take note that we commit ourselves to answer all your questions in a 48 term, working day as long as your data has been filled in properly.