dermava.com
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8.36.41.58
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Submitted URL: http://beautystoredepot.com/
Effective URL: https://dermava.com/
Submission Tags: tranco_l324
Submission: On May 15 via api from DE — Scanned from DE
Effective URL: https://dermava.com/
Submission Tags: tranco_l324
Submission: On May 15 via api from DE — Scanned from DE
Form analysis 7 forms found in the DOM
GET https://dermava.com/catalogsearch/result/
<form class="form minisearch" id="search_mini_form" action="https://dermava.com/catalogsearch/result/" method="get">
<div class="field search"><label class="label" for="search" data-role="minisearch-label"><span>Search</span></label>
<div class="control">
<div class="amsearch-wrapper-input -bottom-position" data-amsearch-js="search-wrapper-input" style="width: 100%;"><input id="search" type="text" name="q" value="" placeholder="Search Store" class="input-text search-mag-glass" maxlength="100"
role="combobox" aria-haspopup="false" aria-autocomplete="both" autocomplete="off" aria-expanded="false">
<div data-amsearch-js="loader" class="amasty-xsearch-loader" style="display: none;"></div><button class="amsearch-loupe" title="Search" type="submit" data-amsearch-js="loupe" style="display: inline-block;" disabled=""></button>
<div class="amsearch-close" title="Clear Field" data-amsearch-js="close" style="display: block;"></div>
</div>
<div class="mst-searchautocomplete__autocomplete search-autocomplete -bottom-position amsearch-clone-position" id="mst_search_autocomplete">
<div class="mst-searchautocomplete__spinner">
<div class="spinner-item spinner-item-1"></div>
<div class="spinner-item spinner-item-2"></div>
<div class="spinner-item spinner-item-3"></div>
<div class="spinner-item spinner-item-4"></div>
</div>
</div>
<div id="search_autocomplete" class="search-autocomplete"></div>
</div>
</div>
<div class="actions"><button type="submit" title="Search" class="action search" aria-label="Search"><span>Search</span></button></div>
</form>POST #
<form id="popup_hide_form" novalidate="" action="#" method="POST" style="display:none;"><input name="form_key" type="hidden" value="sRClyrsFKgaX72PW"> </form>POST #
<form class="form password forget" action="#" method="post" id="form-forgotpassword" novalidate="novalidate">
<div style="display:none;" class="alert alert-success hide"></div>
<div class="popup-errors alert alert-error hide"></div>
<fieldset class="fieldset" data-hasrequired="* Required Fields">
<div class="field note">Please enter your email address below to receive a password reset link.</div>
<div class="field email required"><label for="email_address" class="label"><span>Email</span></label>
<div class="control"><input autocomplete="off" type="email" name="email" alt="email" id="email_address" class="input-text" value="" data-validate="{required:true, 'validate-email':true}" aria-required="true"></div>
</div> <!--<div class="g-recaptcha" data-sitekey="6Lc1qx4eAAAAADSVZEjKWmmcTlf6R2lTQMAkynWr" data-callback="onSubmit" data-size="invisible"></div>-->
</fieldset>
<div class="actions-toolbar">
<div class="primary"><button type="button" class="action submit primary resetpasssword"><span>Reset My Password</span></button></div>
</div>
<div class="actions-toolbar back">
<div class="primary"><button type="button" class="primary backtologin"><span>Back</span></button></div>
</div>
</form>POST #
<form id="register_form" novalidate="" action="#" method="POST" enctype="multipart/form-data"><input name="form_key" type="hidden" value="sRClyrsFKgaX72PW">
<fieldset class="step-one">
<div class="step1 row">
<p class="steptitle">Virtual Dermatologist Consult</p><br>
<p>Fill out our medical questionnaire for your personal dermatological profile and to screen your products automatically. You will receive an analysis and skincare plan based on your profile.</p>
<div class="form-group field col-12 col-sm-6 firstname required"><label for="firstname" class="label"><span> First Name</span></label>
<div class="control"><input type="text" name="firstname" id="firstname-reg" value="" title="First Name" class="input-text firstname"></div>
</div>
<div class="form-group field col-12 col-sm-6 lastname required"><label for="lastname" class="label"><span> Last Name</span></label>
<div class="control"><input type="text" name="lastname" id="lastname-reg" value="" title="Last Name" class="input-text lastname"></div>
</div>
<div class="form-group field col-12 col-sm-6 phone "><label for="phone" class="label"><span> Phone</span></label>
<div class="control"><input type="text" name="phone" id="phone-reg" value="" title="Phone" class="input-text phone" maxlength="12"></div>
</div>
<script>
require(['jquery'], function($) {
$('[id*=phone]').on('keypress', function(e) {
var number = $(this).val();
var keyCode = e.which ? e.which : e.keyCode;
if ((keyCode >= 48 && keyCode <= 57)) {
if (number.length == 3) {
$(this).val($(this).val() + '-');
} else if (number.length == 7) {
$(this).val($(this).val() + '-');
}
} else {
return false;
}
});
});
</script>
<script>
require(['jquery'], function($) {
$('[id*=popup-reg-dob]').on('keypress', function(e) {
var number = $(this).val();
var keyCode = e.which ? e.which : e.keyCode;
if ((keyCode >= 48 && keyCode <= 57)) {
var v = $(this).val();
if (v.match(/^\d{2}$/) !== null) {
$(this).val(v + '/');
} else if (v.match(/^\d{2}\/\d{2}$/) !== null) {
$(this).val(v + '/');
}
} else {
return false;
}
});
});
</script>
<div class="form-group field date col-12 col-sm-6 dob">
<div class="control customer-dob">
<div class="field"><label> <span> Date of Birth</span></label> <input type="text" name="dob" maxlength="10" class="input-text" id="popup-reg-dob"></div>
</div>
</div>
<div class="form-group field col-12 col-sm-6 gender required"><label for="gender" class="label"><span> Gender</span></label>
<div class="control"><select name="gender" id="gender-reg" title="Gender" class="">
<option value="" selected=""> </option>
<option value="1">Male</option>
<option value="2">Female</option>
<option value="3">Not Specified</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 female_selected "><label for="female_selected" class="label"><span> Are you pregnant or planning to be?</span></label>
<div class="control"><select name="female_selected" id="female_selected-reg" title="Are you pregnant or planning to be?" class="">
<option value="" selected=""> </option>
<option value="2878">No</option>
<option value="2879">Yes</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 skintype required"><label for="skintype" class="label"><span> Skin Type</span></label>
<div class="control"><select name="skintype" id="skintype-reg" title="Skin Type" class="">
<option value="" selected=""> </option>
<option value="1386">Dry Skin</option>
<option value="1387">Normal Skin</option>
<option value="2442">Combination Skin</option>
<option value="1388">Oily Skin</option>
</select></div>
</div>
<div class="form-group field col-12 skincolor required"><label for="skincolor-reg" class="label"><span> Skin Tone</span></label>
<div class="control" style="display:flex;flex-wrap:wrap">
<div class="control nested-control" style="padding:0px 5px 5px"><input type="radio" name="skincolor" value="951" id="skincolor-reg-951" class="input-radion"><label for="skincolor-reg-951" class="mytooltip skincolor-tooltip"
style="background-color:#f4d0b1"><span class="mytext">
<div class="fstline">TYPE I</div>
<div class="sndline">
<div><span class="secondline">Light, Pale White<br><span class="thirdline">Always burns, Never tans</span></span></div>
</div>
</span></label></div>
<div class="control nested-control" style="padding:0px 5px 5px"><input type="radio" name="skincolor" value="952" id="skincolor-reg-952" class="input-radion"><label for="skincolor-reg-952" class="mytooltip skincolor-tooltip"
style="background-color:#e7b48f"><span class="mytext">
<div class="fstline">TYPE II</div>
<div class="sndline">
<div><span class="secondline">White, Fair<br><span class="thirdline">Usually burns, Tans with difficulty</span></span></div>
</div>
</span></label></div>
<div class="control nested-control" style="padding:0px 5px 5px"><input type="radio" name="skincolor" value="953" id="skincolor-reg-953" class="input-radion"><label for="skincolor-reg-953" class="mytooltip skincolor-tooltip"
style="background-color:#d29f7c"><span class="mytext">
<div class="fstline">TYPE III</div>
<div class="sndline">
<div><span class="secondline">Medium, White to olive<br><span class="thirdline">Sometimes mild burn, Gradually tans to olive</span></span></div>
</div>
</span></label></div>
<div class="control nested-control" style="padding:0px 5px 5px"><input type="radio" name="skincolor" value="954" id="skincolor-reg-954" class="input-radion"><label for="skincolor-reg-954" class="mytooltip skincolor-tooltip"
style="background-color:#ba7750"><span class="mytext">
<div class="fstline">TYPE IV</div>
<div class="sndline">
<div><span class="secondline">Olive, Moderate brown<br><span class="thirdline">Rarely burns, Tans with ease to a moderate brown</span></span></div>
</div>
</span></label></div>
<div class="control nested-control" style="padding:0px 5px 5px"><input type="radio" name="skincolor" value="955" id="skincolor-reg-955" class="input-radion"><label for="skincolor-reg-955" class="mytooltip skincolor-tooltip"
style="background-color:#a55e2b"><span class="mytext">
<div class="fstline">TYPE V</div>
<div class="sndline">
<div><span class="secondline">Brown, Dark brown<br><span class="thirdline">Very rarely burns, Tans very easily</span></span></div>
</div>
</span></label></div>
<div class="control nested-control" style="padding:0px 5px 5px"><input type="radio" name="skincolor" value="956" id="skincolor-reg-956" class="input-radion"><label for="skincolor-reg-956" class="mytooltip skincolor-tooltip"
style="background-color:#3c201d"><span class="mytext">
<div class="fstline">TYPE VI</div>
<div class="sndline">
<div><span class="secondline">Black, Very dark brown to black<br><span class="thirdline">Never burns, Tans very easily, Deeply pigmented</span></span></div>
</div>
</span></label></div>
</div>
</div>
<div id="accordion_healthproblemaware" class="">
<div data-role="collapsible" class="secondotherconcern">
<div data-role="trigger">
<div class="form-group field healthproblemaware required"><label for="healthproblemaware-reg" class="label "> <span> Do You Have Any Of These Health Problems?</span> </label></div>
</div>
</div>
<div data-role="content">
<div class="row ">
<div class="col-6 col-md-4">
<div class="customimage-0"></div><input type="checkbox" id="healthproblemaware1-reg" name="healthproblemaware[]" value="2495"><label class="multiselectlabel" for="healthproblemaware1-reg"> None</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-1"></div><input type="checkbox" id="healthproblemaware2-reg" name="healthproblemaware[]" value="1451"><label class="multiselectlabel" for="healthproblemaware2-reg">Anxiety or Depression</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-2"></div><input type="checkbox" id="healthproblemaware3-reg" name="healthproblemaware[]" value="1452"><label class="multiselectlabel" for="healthproblemaware3-reg">Autoimmune</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-3"></div><input type="checkbox" id="healthproblemaware4-reg" name="healthproblemaware[]" value="2449"><label class="multiselectlabel" for="healthproblemaware4-reg">Cancer</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-4"></div><input type="checkbox" id="healthproblemaware5-reg" name="healthproblemaware[]" value="1453"><label class="multiselectlabel" for="healthproblemaware5-reg">Diabetes</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-5"></div><input type="checkbox" id="healthproblemaware6-reg" name="healthproblemaware[]" value="1454"><label class="multiselectlabel" for="healthproblemaware6-reg">Kidney Issues</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-6"></div><input type="checkbox" id="healthproblemaware7-reg" name="healthproblemaware[]" value="1455"><label class="multiselectlabel" for="healthproblemaware7-reg">Thyroid Problems</label><br>
</div>
</div>
</div>
</div>
<div id="accordion_allergies" class="">
<div data-role="collapsible" class="secondotherconcern">
<div data-role="trigger">
<div class="form-group field allergies required"><label for="allergies-reg" class="label "> <span> Do You Have Any Of These Allergies or Sensitivities?</span> </label></div>
</div>
</div>
<div data-role="content">
<div class="row ">
<div class="col-6 col-md-4">
<div class="customimage-0"></div><input type="checkbox" id="allergies1-reg" name="allergies[]" value="2494"><label class="multiselectlabel" for="allergies1-reg"> None</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-1"></div><input type="checkbox" id="allergies2-reg" name="allergies[]" value="2455"><label class="multiselectlabel" for="allergies2-reg">Aspirin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-2"></div><input type="checkbox" id="allergies3-reg" name="allergies[]" value="2539"><label class="multiselectlabel" for="allergies3-reg">Coconut</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-3"></div><input type="checkbox" id="allergies4-reg" name="allergies[]" value="2456"><label class="multiselectlabel" for="allergies4-reg">Dyes</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-4"></div><input type="checkbox" id="allergies5-reg" name="allergies[]" value="1456"><label class="multiselectlabel" for="allergies5-reg">Fragrance</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-5"></div><input type="checkbox" id="allergies6-reg" name="allergies[]" value="2537"><label class="multiselectlabel" for="allergies6-reg">Fruits</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-6"></div><input type="checkbox" id="allergies7-reg" name="allergies[]" value="2457"><label class="multiselectlabel" for="allergies7-reg">Gluten</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-7"></div><input type="checkbox" id="allergies8-reg" name="allergies[]" value="1457"><label class="multiselectlabel" for="allergies8-reg">Lactose</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-8"></div><input type="checkbox" id="allergies9-reg" name="allergies[]" value="1458"><label class="multiselectlabel" for="allergies9-reg">Latex</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-9"></div><input type="checkbox" id="allergies10-reg" name="allergies[]" value="2458"><label class="multiselectlabel" for="allergies10-reg">Lavender Oil</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-10"></div><input type="checkbox" id="allergies11-reg" name="allergies[]" value="1459"><label class="multiselectlabel" for="allergies11-reg">Parabens</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-11"></div><input type="checkbox" id="allergies12-reg" name="allergies[]" value="2459"><label class="multiselectlabel" for="allergies12-reg">Peanuts</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-12"></div><input type="checkbox" id="allergies13-reg" name="allergies[]" value="2460"><label class="multiselectlabel" for="allergies13-reg">Peppermint Oil</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-13"></div><input type="checkbox" id="allergies14-reg" name="allergies[]" value="2467"><label class="multiselectlabel" for="allergies14-reg">Phthalates</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-14"></div><input type="checkbox" id="allergies15-reg" name="allergies[]" value="3006"><label class="multiselectlabel" for="allergies15-reg">Preservatives</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-15"></div><input type="checkbox" id="allergies16-reg" name="allergies[]" value="2461"><label class="multiselectlabel" for="allergies16-reg">Retinol</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-16"></div><input type="checkbox" id="allergies17-reg" name="allergies[]" value="2462"><label class="multiselectlabel" for="allergies17-reg">Rosemary Leaf Oil</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-17"></div><input type="checkbox" id="allergies18-reg" name="allergies[]" value="2463"><label class="multiselectlabel" for="allergies18-reg">Shellfish</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-18"></div><input type="checkbox" id="allergies19-reg" name="allergies[]" value="2464"><label class="multiselectlabel" for="allergies19-reg">Silicone</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-19"></div><input type="checkbox" id="allergies20-reg" name="allergies[]" value="1460"><label class="multiselectlabel" for="allergies20-reg">Soy</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-20"></div><input type="checkbox" id="allergies21-reg" name="allergies[]" value="2465"><label class="multiselectlabel" for="allergies21-reg">Sulfates</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-21"></div><input type="checkbox" id="allergies22-reg" name="allergies[]" value="2533"><label class="multiselectlabel" for="allergies22-reg">Talc</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-22"></div><input type="checkbox" id="allergies23-reg" name="allergies[]" value="2448"><label class="multiselectlabel" for="allergies23-reg">Tree Nuts</label><br>
</div>
</div>
</div>
</div>
<div style="color:#ff0000;" class="popup-validation-errors alert validation-alert-error hide"></div>
</div><button type="button" name="next" class="next-form btn btn-info">Next<i style="padding-left:10px" class="fas fa-arrow-right"></i></button>
</fieldset>
<fieldset class="step-two">
<div class="step1 row">
<p class="steptitle">Current Regimen</p><br>
<p>Tell us a little bit about what you are doing currently and how it is working for you.</p>
<div class="form-group field col-12 col-sm-6 timespentonroutine "><label for="timespentonroutine" class="label"><span> How much time do you spend on your routine?</span></label>
<div class="control"><select name="timespentonroutine" id="timespentonroutine-reg" title="How much time do you spend on your routine?" class="">
<option value="" selected=""> </option>
<option value="2468">I don't have a routine</option>
<option value="2469">Under 5 minutes</option>
<option value="2470">5-10 minutes</option>
<option value="2471">10+ minutes</option>
</select></div>
</div>
<div id="accordion_whendoyoudoroutine" class="col-12 col-sm-6">
<div data-role="collapsible" class="secondotherconcern">
<div data-role="trigger">
<div class="form-group field whendoyoudoroutine "><label for="whendoyoudoroutine-reg" class="label "> <span> When do you do your routine?</span> </label></div>
</div>
</div>
<div data-role="content">
<div class="row ">
<div class="col-6 col-md-4">
<div class="customimage-0"></div><input type="checkbox" id="whendoyoudoroutine1-reg" name="whendoyoudoroutine[]" value="2472"><label class="multiselectlabel" for="whendoyoudoroutine1-reg">Morning</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-1"></div><input type="checkbox" id="whendoyoudoroutine2-reg" name="whendoyoudoroutine[]" value="2473"><label class="multiselectlabel" for="whendoyoudoroutine2-reg">Night</label><br>
</div>
</div>
</div>
</div>
<div class="form-group field col-12 routinemeetingexpectation "><label for="routinemeetingexpectation" class="label"><span> Is your routine meeting your expectations?</span></label>
<div class="control"><select name="routinemeetingexpectation" id="routinemeetingexpectation-reg" title="Is your routine meeting your expectations?" class="">
<option value="" selected=""> </option>
<option value="2876">No</option>
<option value="2877">Yes</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 cleanser "><label for="cleanser" class="label"><span> What cleanser are you currently using?</span></label>
<div class="control"><input type="text" name="cleanser" id="cleanser-reg" value="" title="What cleanser are you currently using?" class="input-text cleanser"></div>
</div>
<div class="form-group field col-12 col-sm-6 keepcleanser "><label for="keepcleanser" class="label"><span> Are you satisfied with your cleanser?</span></label>
<div class="control"><select name="keepcleanser" id="keepcleanser-reg" title="Are you satisfied with your cleanser?" class="">
<option value="" selected=""> </option>
<option value="2882">No</option>
<option value="2883">Yes</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 toner "><label for="toner" class="label"><span> What toner are you currently using?</span></label>
<div class="control"><input type="text" name="toner" id="toner-reg" value="" title="What toner are you currently using?" class="input-text toner"></div>
</div>
<div class="form-group field col-12 col-sm-6 keeptoner "><label for="keeptoner" class="label"><span> Are you satisfied with your toner?</span></label>
<div class="control"><select name="keeptoner" id="keeptoner-reg" title="Are you satisfied with your toner?" class="">
<option value="" selected=""> </option>
<option value="2890">No</option>
<option value="2891">Yes</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 serum "><label for="serum" class="label"><span> What serum are you currently using?</span></label>
<div class="control"><input type="text" name="serum" id="serum-reg" value="" title="What serum are you currently using?" class="input-text serum"></div>
</div>
<div class="form-group field col-12 col-sm-6 keepserum "><label for="keepserum" class="label"><span> Are you satisfied with your serum?</span></label>
<div class="control"><select name="keepserum" id="keepserum-reg" title="Are you satisfied with your serum?" class="">
<option value="" selected=""> </option>
<option value="2886">No</option>
<option value="2887">Yes</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 moisturizer "><label for="moisturizer" class="label"><span> What moisturizer are you currently using?</span></label>
<div class="control"><input type="text" name="moisturizer" id="moisturizer-reg" value="" title="What moisturizer are you currently using?" class="input-text moisturizer"></div>
</div>
<div class="form-group field col-12 col-sm-6 keepmoisturizer "><label for="keepmoisturizer" class="label"><span> Are you satisfied with your moisturizer?</span></label>
<div class="control"><select name="keepmoisturizer" id="keepmoisturizer-reg" title="Are you satisfied with your moisturizer?" class="">
<option value="" selected=""> </option>
<option value="2884">No</option>
<option value="2885">Yes</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 sunscreen "><label for="sunscreen" class="label"><span> What sunscreen are you currently using?</span></label>
<div class="control"><input type="text" name="sunscreen" id="sunscreen-reg" value="" title="What sunscreen are you currently using?" class="input-text sunscreen"></div>
</div>
<div class="form-group field col-12 col-sm-6 keepsunscreen "><label for="keepsunscreen" class="label"><span> Are you satisfied with your sunscreen?</span></label>
<div class="control"><select name="keepsunscreen" id="keepsunscreen-reg" title="Are you satisfied with your sunscreen?" class="">
<option value="" selected=""> </option>
<option value="2888">No</option>
<option value="2889">Yes</option>
</select></div>
</div>
</div><button type="button" name="next" class="next-form btn btn-info">Next<i style="padding-left:10px" class="fas fa-arrow-right"></i></button>
<div class="skip-form"><a href="#">skip</a><i class="fas fa-angle-right"></i></div>
<div class="previous-form"><i class="fas fa-angle-left"></i>back</div>
</fieldset>
<fieldset class="step-three">
<div class="step1 row">
<p class="steptitle">Issues and Expectations</p><br>
<p>Tell us a bit about the issues you are experiencing and what you want to accomplish.</p>
<div class="form-group field col-12 hopingaccomplish "><label for="hopingaccomplish" class="label"><span> What are you hoping to accomplish with our help?</span></label>
<div class="control"><textarea type="text" name="hopingaccomplish" id="hopingaccomplish-reg" title="What are you hoping to accomplish with our help?" class="input-text "></textarea></div>
</div>
<div id="accordion_primaryconcerns" class="">
<div data-role="collapsible" class="secondotherconcern">
<div data-role="trigger">
<div class="form-group field primaryconcerns "><label for="primaryconcerns-reg" class="label "> <span> What Are Your Primary Concerns?</span> </label></div>
</div>
</div>
<div data-role="content">
<div class="row ">
<div class="col-6 col-md-4">
<div class="customimage-0"></div><input type="checkbox" id="primaryconcerns1-reg" name="primaryconcerns[]" value="2505"><label class="multiselectlabel" for="primaryconcerns1-reg"> None</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-1"></div><input type="checkbox" id="primaryconcerns2-reg" name="primaryconcerns[]" value="1402"><label class="multiselectlabel" for="primaryconcerns2-reg">Acne & Blemishes</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-2"></div><input type="checkbox" id="primaryconcerns3-reg" name="primaryconcerns[]" value="1403"><label class="multiselectlabel" for="primaryconcerns3-reg">Aging Skin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-3"></div><input type="checkbox" id="primaryconcerns4-reg" name="primaryconcerns[]" value="1404"><label class="multiselectlabel" for="primaryconcerns4-reg">Dark Spots</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-4"></div><input type="checkbox" id="primaryconcerns5-reg" name="primaryconcerns[]" value="1405"><label class="multiselectlabel" for="primaryconcerns5-reg">Dry Skin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-5"></div><input type="checkbox" id="primaryconcerns6-reg" name="primaryconcerns[]" value="1406"><label class="multiselectlabel" for="primaryconcerns6-reg">Eczema</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-6"></div><input type="checkbox" id="primaryconcerns7-reg" name="primaryconcerns[]" value="1407"><label class="multiselectlabel" for="primaryconcerns7-reg">Fine Lines & Wrinkles</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-7"></div><input type="checkbox" id="primaryconcerns8-reg" name="primaryconcerns[]" value="1408"><label class="multiselectlabel" for="primaryconcerns8-reg">Irritated Skin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-8"></div><input type="checkbox" id="primaryconcerns9-reg" name="primaryconcerns[]" value="1409"><label class="multiselectlabel" for="primaryconcerns9-reg">Large Pores</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-9"></div><input type="checkbox" id="primaryconcerns10-reg" name="primaryconcerns[]" value="1410"><label class="multiselectlabel" for="primaryconcerns10-reg">Oil Control</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-10"></div><input type="checkbox" id="primaryconcerns11-reg" name="primaryconcerns[]" value="1411"><label class="multiselectlabel" for="primaryconcerns11-reg">Pigmentation</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-11"></div><input type="checkbox" id="primaryconcerns12-reg" name="primaryconcerns[]" value="1412"><label class="multiselectlabel" for="primaryconcerns12-reg">Psoriasis</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-12"></div><input type="checkbox" id="primaryconcerns13-reg" name="primaryconcerns[]" value="1413"><label class="multiselectlabel" for="primaryconcerns13-reg">Redness & Rosacea</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-13"></div><input type="checkbox" id="primaryconcerns14-reg" name="primaryconcerns[]" value="1414"><label class="multiselectlabel" for="primaryconcerns14-reg">Scars</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-14"></div><input type="checkbox" id="primaryconcerns15-reg" name="primaryconcerns[]" value="1415"><label class="multiselectlabel" for="primaryconcerns15-reg">Sensitive Skin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-15"></div><input type="checkbox" id="primaryconcerns16-reg" name="primaryconcerns[]" value="1416"><label class="multiselectlabel" for="primaryconcerns16-reg">Stretch Marks</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-16"></div><input type="checkbox" id="primaryconcerns17-reg" name="primaryconcerns[]" value="2528"><label class="multiselectlabel" for="primaryconcerns17-reg">Sun Protection</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-17"></div><input type="checkbox" id="primaryconcerns18-reg" name="primaryconcerns[]" value="2527"><label class="multiselectlabel" for="primaryconcerns18-reg">Sunburn</label><br>
</div>
</div>
</div>
</div>
<div id="accordion_otherconcerns" class="mage-accordion-disabled" role="tablist">
<div data-role="collapsible" class="secondotherconcern" role="tab" data-collapsible="true" aria-selected="false" aria-expanded="false">
<div data-role="trigger" tabindex="0">
<div class="form-group field otherconcerns "><label for="otherconcerns-reg" class="label "> <span> Any Other Concerns?</span> <i class="fas fa-angle-down"></i></label></div>
</div>
</div>
<div data-role="content" role="tabpanel" aria-hidden="true" style="display: none;">
<div class="row ">
<div class="col-6 col-md-4">
<div class="customimage-0"></div><input type="checkbox" id="otherconcerns1-reg" name="otherconcerns[]" value="2504"><label class="multiselectlabel" for="otherconcerns1-reg"> None</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-1"></div><input type="checkbox" id="otherconcerns2-reg" name="otherconcerns[]" value="1417"><label class="multiselectlabel" for="otherconcerns2-reg">Black Heads</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-2"></div><input type="checkbox" id="otherconcerns3-reg" name="otherconcerns[]" value="1418"><label class="multiselectlabel" for="otherconcerns3-reg">Bruising</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-3"></div><input type="checkbox" id="otherconcerns4-reg" name="otherconcerns[]" value="1419"><label class="multiselectlabel" for="otherconcerns4-reg">Calluses</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-4"></div><input type="checkbox" id="otherconcerns5-reg" name="otherconcerns[]" value="1421"><label class="multiselectlabel" for="otherconcerns5-reg">Cellulite</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-5"></div><input type="checkbox" id="otherconcerns6-reg" name="otherconcerns[]" value="1422"><label class="multiselectlabel" for="otherconcerns6-reg">Chapped Lips</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-6"></div><input type="checkbox" id="otherconcerns7-reg" name="otherconcerns[]" value="1423"><label class="multiselectlabel" for="otherconcerns7-reg">Cold Sores</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-7"></div><input type="checkbox" id="otherconcerns8-reg" name="otherconcerns[]" value="1424"><label class="multiselectlabel" for="otherconcerns8-reg">Crepey Skin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-8"></div><input type="checkbox" id="otherconcerns9-reg" name="otherconcerns[]" value="1425"><label class="multiselectlabel" for="otherconcerns9-reg">Crow's Feet</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-9"></div><input type="checkbox" id="otherconcerns10-reg" name="otherconcerns[]" value="1426"><label class="multiselectlabel" for="otherconcerns10-reg">Cystic Acne</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-10"></div><input type="checkbox" id="otherconcerns11-reg" name="otherconcerns[]" value="2451"><label class="multiselectlabel" for="otherconcerns11-reg">Dark Circles</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-11"></div><input type="checkbox" id="otherconcerns12-reg" name="otherconcerns[]" value="1427"><label class="multiselectlabel" for="otherconcerns12-reg">Firmness</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-12"></div><input type="checkbox" id="otherconcerns13-reg" name="otherconcerns[]" value="1428"><label class="multiselectlabel" for="otherconcerns13-reg">Free Radical Damage</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-13"></div><input type="checkbox" id="otherconcerns14-reg" name="otherconcerns[]" value="1429"><label class="multiselectlabel" for="otherconcerns14-reg">Hyper Pigmentation</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-14"></div><input type="checkbox" id="otherconcerns15-reg" name="otherconcerns[]" value="1430"><label class="multiselectlabel" for="otherconcerns15-reg">Ingrown Hairs</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-15"></div><input type="checkbox" id="otherconcerns16-reg" name="otherconcerns[]" value="1431"><label class="multiselectlabel" for="otherconcerns16-reg">Itchy Skin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-16"></div><input type="checkbox" id="otherconcerns17-reg" name="otherconcerns[]" value="1432"><label class="multiselectlabel" for="otherconcerns17-reg">Keratosis Pillaris</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-17"></div><input type="checkbox" id="otherconcerns18-reg" name="otherconcerns[]" value="1433"><label class="multiselectlabel" for="otherconcerns18-reg">Lip Lines</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-18"></div><input type="checkbox" id="otherconcerns19-reg" name="otherconcerns[]" value="1434"><label class="multiselectlabel" for="otherconcerns19-reg">Melasma</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-19"></div><input type="checkbox" id="otherconcerns20-reg" name="otherconcerns[]" value="1435"><label class="multiselectlabel" for="otherconcerns20-reg">Milia</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-20"></div><input type="checkbox" id="otherconcerns21-reg" name="otherconcerns[]" value="1436"><label class="multiselectlabel" for="otherconcerns21-reg">Pollution</label><br>
</div>
</div>
</div>
</div>
<div id="accordion_concernareas" class="">
<div data-role="collapsible" class="secondotherconcern">
<div data-role="trigger">
<div class="form-group field concernareas "><label for="concernareas-reg" class="label "> <span> What Are Your Concern Areas?</span> </label></div>
</div>
</div>
<div data-role="content">
<div class="row ">
<div class="col-6 col-md-4">
<div class="customimage-0"></div><input type="checkbox" id="concernareas1-reg" name="concernareas[]" value="2875"><label class="multiselectlabel" for="concernareas1-reg"> None</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-1"></div><input type="checkbox" id="concernareas2-reg" name="concernareas[]" value="1437"><label class="multiselectlabel" for="concernareas2-reg">Abdomen</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-2"></div><input type="checkbox" id="concernareas3-reg" name="concernareas[]" value="2452"><label class="multiselectlabel" for="concernareas3-reg">Arms/Legs</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-3"></div><input type="checkbox" id="concernareas4-reg" name="concernareas[]" value="2453"><label class="multiselectlabel" for="concernareas4-reg">Back</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-4"></div><input type="checkbox" id="concernareas5-reg" name="concernareas[]" value="1438"><label class="multiselectlabel" for="concernareas5-reg">Cheeks</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-5"></div><input type="checkbox" id="concernareas6-reg" name="concernareas[]" value="2480"><label class="multiselectlabel" for="concernareas6-reg">Chin</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-6"></div><input type="checkbox" id="concernareas7-reg" name="concernareas[]" value="1439"><label class="multiselectlabel" for="concernareas7-reg">Décolleté</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-7"></div><input type="checkbox" id="concernareas8-reg" name="concernareas[]" value="1440"><label class="multiselectlabel" for="concernareas8-reg">Eyebrows</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-8"></div><input type="checkbox" id="concernareas9-reg" name="concernareas[]" value="1441"><label class="multiselectlabel" for="concernareas9-reg">Eyelashes</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-9"></div><input type="checkbox" id="concernareas10-reg" name="concernareas[]" value="1442"><label class="multiselectlabel" for="concernareas10-reg">Eyes</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-10"></div><input type="checkbox" id="concernareas11-reg" name="concernareas[]" value="1443"><label class="multiselectlabel" for="concernareas11-reg">Face</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-11"></div><input type="checkbox" id="concernareas12-reg" name="concernareas[]" value="1444"><label class="multiselectlabel" for="concernareas12-reg">Feet</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-12"></div><input type="checkbox" id="concernareas13-reg" name="concernareas[]" value="2479"><label class="multiselectlabel" for="concernareas13-reg">Forehead</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-13"></div><input type="checkbox" id="concernareas14-reg" name="concernareas[]" value="1445"><label class="multiselectlabel" for="concernareas14-reg">Hair</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-14"></div><input type="checkbox" id="concernareas15-reg" name="concernareas[]" value="1446"><label class="multiselectlabel" for="concernareas15-reg">Hands</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-15"></div><input type="checkbox" id="concernareas16-reg" name="concernareas[]" value="1447"><label class="multiselectlabel" for="concernareas16-reg">Lips</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-16"></div><input type="checkbox" id="concernareas17-reg" name="concernareas[]" value="1448"><label class="multiselectlabel" for="concernareas17-reg">Nails</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-17"></div><input type="checkbox" id="concernareas18-reg" name="concernareas[]" value="1449"><label class="multiselectlabel" for="concernareas18-reg">Neck</label><br>
</div>
<div class="col-6 col-md-4">
<div class="customimage-18"></div><input type="checkbox" id="concernareas19-reg" name="concernareas[]" value="1450"><label class="multiselectlabel" for="concernareas19-reg">Scalp</label><br>
</div>
</div>
</div>
</div>
</div><button type="button" name="next" class="next-form btn btn-info">Next<i style="padding-left:10px" class="fas fa-arrow-right"></i></button>
<div class="skip-form"><a href="#">skip</a><i class="fas fa-angle-right"></i></div>
<div class="previous-form"><i class="fas fa-angle-left"></i><a href="#">back</a></div>
</fieldset>
<fieldset class="step-four">
<div class="step1 row">
<p class="steptitle">Health and Lifestyle</p><br>
<p>Your overall health and lifestyle has a large impact on your skincare needs.</p>
<div class="form-group field col-12 anythingelsehealth "><label for="anythingelsehealth" class="label"><span> Anything else we should be aware of?</span></label>
<div class="control"><textarea type="text" name="anythingelsehealth" id="anythingelsehealth-reg" title="Anything else we should be aware of?" class="input-text "></textarea></div>
</div>
<div class="form-group field col-12 col-sm-6 oftenfeelstressed "><label for="oftenfeelstressed" class="label"><span> How Often Do You Feel Stressed?</span></label>
<div class="control"><select name="oftenfeelstressed" id="oftenfeelstressed-reg" title="How Often Do You Feel Stressed?" class="">
<option value="" selected=""> </option>
<option value="1462">Never</option>
<option value="1463">Occasioanlly</option>
<option value="1464">Always</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 sleeppernight "><label for="sleeppernight" class="label"><span> How Much Do You Sleep Per Night?</span></label>
<div class="control"><select name="sleeppernight" id="sleeppernight-reg" title="How Much Do You Sleep Per Night?" class="">
<option value="" selected=""> </option>
<option value="1465">1-4 Hours</option>
<option value="1466">4-7 Hours</option>
<option value="1467">7+ Hours</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 oftenexercise "><label for="oftenexercise" class="label"><span> How Often Do You Exercise?</span></label>
<div class="control"><select name="oftenexercise" id="oftenexercise-reg" title="How Often Do You Exercise?" class="">
<option value="" selected=""> </option>
<option value="1468">Never</option>
<option value="1469">1-3 Days a Week</option>
<option value="1470">3+ Days a Week</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 ofteneat "><label for="ofteneat" class="label"><span> How Often Do You Eat Out?</span></label>
<div class="control"><select name="ofteneat" id="ofteneat-reg" title="How Often Do You Eat Out?" class="">
<option value="" selected=""> </option>
<option value="1471">Never</option>
<option value="1472">1-3 Times a Week</option>
<option value="1473">Whats a Kitchen?</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 sunexposure "><label for="sunexposure" class="label"><span> Daily Sun Exposure</span></label>
<div class="control"><select name="sunexposure" id="sunexposure-reg" title="Daily Sun Exposure" class="">
<option value="" selected=""> </option>
<option value="1477">0-1 Hours</option>
<option value="1478">1-3 Hours</option>
<option value="1479">3+ Hours</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 alcoholintake "><label for="alcoholintake" class="label"><span> Daily Alcohol Intake</span></label>
<div class="control"><select name="alcoholintake" id="alcoholintake-reg" title="Daily Alcohol Intake" class="">
<option value="" selected=""> </option>
<option value="1480">0-1</option>
<option value="1481">1-2</option>
<option value="1482">2+</option>
</select></div>
</div>
<div class="form-group field col-12 col-sm-6 smokinghistory "><label for="smokinghistory" class="label"><span> Smoking History</span></label>
<div class="control"><select name="smokinghistory" id="smokinghistory-reg" title="Smoking History" class="">
<option value="" selected=""> </option>
<option value="1483">Never</option>
<option value="1484">Occasionally</option>
<option value="1485">Current smoker</option>
</select></div>
</div>
</div><input type="submit" name="Give My Recommendations" class="submit btn btn-success popupaction" value="Complete My Profile">
<div class="previous-form"><i class="fas fa-angle-left"></i><a href="#">back</a></div>
</fieldset>
</form>POST
<form class="form form-login" method="post" autocomplete="off" data-bind="afterRender: initValidation, event: {submit: login }" id="ajaxlogin-form" novalidate="novalidate">
<div class="fieldset login" data-bind="attr: {'data-hasrequired': $t('* Required Fields')}" data-hasrequired="* Required Fields">
<div class="field email required"><label class="label" for="ajaxlogin-email"><span data-bind="i18n: 'Email Address'">Email Address</span></label>
<div class="control"><input name="username" id="ajaxlogin-email" type="email" placeholder="Email Address" class="input-text" autocomplete="off" data-bind="textInput: email" data-validate="{required:true, 'validate-email':true}"
aria-required="true"></div>
</div>
<div class="password-container">
<div class="field password required"><label for="ajaxlogin-pass" class="label"><span data-bind="i18n: 'Password'">Password</span></label>
<div class="control"><input name="password" type="text" class="input-text" id="ajaxlogin-pass" autocomplete="off" data-bind="fadeVisible: isPasswordEnabled(), attr: {placeholder: isEmailAvailable() ? 'Create Password' : 'Password' }"
data-validate="{required:true}" aria-required="true" placeholder="Password" style="display: none;"></div>
</div>
<div class="actions-toolbar" data-bind="fadeVisible: isLoginVisible()" style="display: none;">
<div class="secondary" data-bind="visible: !isEmailAvailable()"><span class="pwdtext">Lost password?</span> <a class="action forgotpassword-link" href="#"><span data-bind="i18n: 'Recover password'">Recover password</span></a></div>
<div class="primary"><button type="submit" class="action action-login secondary" name="send" id="ajaxlogin-send" data-bind="enable: !hasError()"><span data-bind="i18n: isEmailAvailable() ? 'Create an Account' : 'LOGIN'">LOGIN</span></button>
</div>
</div>
</div><!-- ko foreach: getRegion('additional-login-form-fields') --><!-- /ko --><!--<div class="g-recaptcha" data-sitekey="6Lc1qx4eAAAAADSVZEjKWmmcTlf6R2lTQMAkynWr" data-callback="onSubmit" data-size="invisible"></div>--> <input name="form_key"
type="hidden" value="sRClyrsFKgaX72PW">
</div>
</form>POST
<form class="form form-login" method="post" data-bind="afterRender: initValidation, event: {submit: login }" autocomplete="off" id="ajaxlogin-form" novalidate="novalidate">
<div class="fieldset login" data-bind="attr: {'data-hasrequired': $t('* Required Fields')}" data-hasrequired="* Required Fields">
<div class="field email required"><!-- <label class="label" for="ajaxlogin-email"><span data-bind="i18n: 'Email Address'"></span></label> -->
<div class="control"><input name="username" id="ajaxlogin-email" type="email" autocomplete="off" placeholder="Email Address" class="input-text" data-bind="textInput: email" data-validate="{required:true, 'validate-email':true}"
aria-required="true"></div>
</div>
<div class="password-container">
<div class="field password required"><!-- <label for="ajaxlogin-pass" class="label"><span data-bind="i18n: 'Password'"></span></label> -->
<div class="control"><input name="password" type="text" class="input-text" id="ajaxlogin-pass" autocomplete="off" data-bind="fadeVisible: isPasswordEnabled(), attr: {placeholder: isEmailAvailable() ? 'Create Password' : 'Password' }"
data-validate="{required:true}" aria-required="true" placeholder="Password" style="display: none;"></div>
</div>
<div class="actions-toolbar" data-bind="fadeVisible: isLoginVisible()" style="display: none;">
<div class="secondary" data-bind="visible: !isEmailAvailable()"><span class="pwdtext">Lost password?</span> <a class="action forgotpassword-link" href="#"><span data-bind="i18n: 'Recover password'">Recover password</span></a></div>
<div class="primary"><button type="submit" class="action action-login secondary" name="send" id="ajaxlogin-send" data-bind="enable: !hasError()"><span data-bind="i18n: isEmailAvailable() ? 'Create an Account' : 'LOGIN'">LOGIN</span></button>
</div>
</div>
</div><input name="form_key" type="hidden" value="sRClyrsFKgaX72PW">
</div>
</form>POST
<form class="form form-login" method="post" data-bind="event: {submit: login }" id="login-form">
<div class="fieldset login" data-bind="attr: {'data-hasrequired': $t('* Required Fields')}" data-hasrequired="* Required Fields">
<div class="field email required">
<label class="label" for="customer-email"><span data-bind="i18n: 'Email Address'">Email Address</span></label>
<div class="control">
<input name="username" id="customer-email" type="email" class="input-text" data-mage-init="{"mage/trim-input":{}}" data-bind="attr: {autocomplete: autocomplete}" data-validate="{required:true, 'validate-email':true}"
autocomplete="off">
</div>
</div>
<div class="field password required">
<label for="pass" class="label"><span data-bind="i18n: 'Password'">Password</span></label>
<div class="control">
<input name="password" type="password" class="input-text" id="pass" data-bind="attr: {autocomplete: autocomplete}" data-validate="{required:true}" autocomplete="off">
</div>
</div>
<!-- ko foreach: getRegion('additional-login-form-fields') -->
<!-- ko template: getTemplate() -->
<input name="captcha_form_id" type="hidden" data-bind="value: formId, attr: {'data-scope': dataScope}" value="user_login" data-scope="">
<!-- ko if: (isRequired() && getIsVisible())--><!-- /ko -->
<!-- /ko -->
<!-- /ko -->
<div class="actions-toolbar">
<input name="context" type="hidden" value="checkout">
<div class="primary">
<button type="submit" class="action action-login secondary" name="send" id="send2">
<span data-bind="i18n: 'Sign In'">Sign In</span>
</button>
</div>
<div class="secondary">
<a class="action" data-bind="attr: {href: forgotPasswordUrl}" href="https://dermava.com/customer/account/forgotpassword/">
<span data-bind="i18n: 'Forgot Your Password?'">Forgot Your Password?</span>
</a>
</div>
</div>
</div>
</form>Text Content
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Virtual Dermatologist Consult
Fill out our medical questionnaire for your personal dermatological profile and
to screen your products automatically. You will receive an analysis and skincare
plan based on your profile.
First Name
Last Name
Phone
Date of Birth
Gender
Male Female Not Specified
Are you pregnant or planning to be?
No Yes
Skin Type
Dry Skin Normal Skin Combination Skin Oily Skin
Skin Tone
TYPE I
Light, Pale White
Always burns, Never tans
TYPE II
White, Fair
Usually burns, Tans with difficulty
TYPE III
Medium, White to olive
Sometimes mild burn, Gradually tans to olive
TYPE IV
Olive, Moderate brown
Rarely burns, Tans with ease to a moderate brown
TYPE V
Brown, Dark brown
Very rarely burns, Tans very easily
TYPE VI
Black, Very dark brown to black
Never burns, Tans very easily, Deeply pigmented
Do You Have Any Of These Health Problems?
None
Anxiety or Depression
Autoimmune
Cancer
Diabetes
Kidney Issues
Thyroid Problems
Do You Have Any Of These Allergies or Sensitivities?
None
Aspirin
Coconut
Dyes
Fragrance
Fruits
Gluten
Lactose
Latex
Lavender Oil
Parabens
Peanuts
Peppermint Oil
Phthalates
Preservatives
Retinol
Rosemary Leaf Oil
Shellfish
Silicone
Soy
Sulfates
Talc
Tree Nuts
Next
Current Regimen
Tell us a little bit about what you are doing currently and how it is working
for you.
How much time do you spend on your routine?
I don't have a routine Under 5 minutes 5-10 minutes 10+ minutes
When do you do your routine?
Morning
Night
Is your routine meeting your expectations?
No Yes
What cleanser are you currently using?
Are you satisfied with your cleanser?
No Yes
What toner are you currently using?
Are you satisfied with your toner?
No Yes
What serum are you currently using?
Are you satisfied with your serum?
No Yes
What moisturizer are you currently using?
Are you satisfied with your moisturizer?
No Yes
What sunscreen are you currently using?
Are you satisfied with your sunscreen?
No Yes
Next
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Issues and Expectations
Tell us a bit about the issues you are experiencing and what you want to
accomplish.
What are you hoping to accomplish with our help?
What Are Your Primary Concerns?
None
Acne & Blemishes
Aging Skin
Dark Spots
Dry Skin
Eczema
Fine Lines & Wrinkles
Irritated Skin
Large Pores
Oil Control
Pigmentation
Psoriasis
Redness & Rosacea
Scars
Sensitive Skin
Stretch Marks
Sun Protection
Sunburn
Any Other Concerns?
None
Black Heads
Bruising
Calluses
Cellulite
Chapped Lips
Cold Sores
Crepey Skin
Crow's Feet
Cystic Acne
Dark Circles
Firmness
Free Radical Damage
Hyper Pigmentation
Ingrown Hairs
Itchy Skin
Keratosis Pillaris
Lip Lines
Melasma
Milia
Pollution
What Are Your Concern Areas?
None
Abdomen
Arms/Legs
Back
Cheeks
Chin
Décolleté
Eyebrows
Eyelashes
Eyes
Face
Feet
Forehead
Hair
Hands
Lips
Nails
Neck
Scalp
Next
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Health and Lifestyle
Your overall health and lifestyle has a large impact on your skincare needs.
Anything else we should be aware of?
How Often Do You Feel Stressed?
Never Occasioanlly Always
How Much Do You Sleep Per Night?
1-4 Hours 4-7 Hours 7+ Hours
How Often Do You Exercise?
Never 1-3 Days a Week 3+ Days a Week
How Often Do You Eat Out?
Never 1-3 Times a Week Whats a Kitchen?
Daily Sun Exposure
0-1 Hours 1-3 Hours 3+ Hours
Daily Alcohol Intake
0-1 1-2 2+
Smoking History
Never Occasionally Current smoker
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