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One-on-one Application

First name

Last name

Email*

Do you live in the United Kingdom?

Yes

What kind of support and outcomes are you seeking?

Tell me about your acne history to date.

Example: When did it start? Was there a trigger? Has it been consistently occurring or does it come and go?

How long have you been trying to clear your acne for?

Less than a year

1-3 years

4-10 years

10-15 years

15+ years

What are your top 3 goals in order of importance to you?

Example: 1. facial acne 2. bloating 3. weight gain

What medications and/or other therapies have you tried to resolve your acne? Let me know if any worked.

Example: Antibiotics, Hormonal Birth Control, Roaccutane, Spironolactone, Supplements, Testing, Elimination diets

For long-term and optimal results my clients work usually with me for a minimum of 4 months. Are you able to commit to this timeframe?

After your FREE Discovery Call, if you proceed with one-on-one support, what is your ideal starting timeline?

Immediatley

Within the next month

I'd like to start in 2-3 months time

I'd like to start in 3+ months

Please use this space to write out any questions or to provide more detail about your health history.

Have you watched the Confident, Calm and Clear Masterclass?

I understand that by submitting this form and booking in a free discovery call I am not only taking a spot away from another acne sufferer in need, but I am also taking away time out of Charlotte's day. (While the call is free, if you do cancel/reschedule without giving 24 hours notice, there will be a £40 no-show fee).

Thank you for completing the application form. Once your application has been reviewed you'll receive an email where you'll be able to book a free 30 min discovery call where we'll discuss working together in more detail and costs. Thank you!