Contact UsAtlanta Acne Specialists 465 Winn Way Suite 211 Decatur, GA 30030 Phone: (404) 900-5152 Today's Date* Full Name* First Last Email* Phone*How long have you been on our program?*Are you still getting new breakouts?*YesNoIs your skin more clear than when you started?*YesNoHow is your diet? Are you eating dairy, peanuts, whey/ soy protein powders, shakes, or bars? Have you limited sodium?*Do you pick at your skin or try to pop pimples yourself?*YesNoFemales: What makeup are you wearing? Please list any and allHow many times per week have you been UNABLE to do your morning routine?*01234567How many times per week have you been UNABLE to do your evening routine?*01234567Write our your routine step-by-step (exactly as you apply them) morning AND evening. It is crucial that we know every step, please fill this out thoroughly even if you do everything as you're instructed. Thank you!*Please list any challenges you are having with the program so we can best support/ guide you.*Are any products stinging or burning? If so, which one(s)?*How is your skin feeling?*Red/ IrritatedOily or NormalDry/ PeelingI am currently playing sports.*YesNoIf yes, which sport?Please list any new medications, vitamins or supplements you have started.*Upload Photos*Please take photos without makeup, preferably in daylight, without a flash, and have someone take them for you if possible. Make sure they are clear, unfiltered and in focus. This will better help us see how your skin is doing. You can upload multiple photos here and please use the larger file size your camera provides (typically 1 to 3 MB). Include a right side, left side, and a front view please. Drop files here or Accepted file types: jpg, jpeg, png, gif. I need to purchase products.*YesNoAdditional Questions/ Comments: This iframe contains the logic required to handle Ajax powered Gravity Forms.