{"id":1823,"date":"2021-11-05T17:10:02","date_gmt":"2021-11-05T17:10:02","guid":{"rendered":"https:\/\/simplyblended.com\/?page_id=1823"},"modified":"2022-04-04T11:09:43","modified_gmt":"2022-04-04T11:09:43","slug":"bespoke_skincare_request","status":"publish","type":"page","link":"https:\/\/simplyblended.com\/bespoke_skincare_request\/","title":{"rendered":"Bespoke skincare Questionnaire"},"content":{"rendered":"<p><a href=\"https:\/\/simplyblended.com\/wp-content\/uploads\/2021\/11\/REJUVANESSENCE11-150x150-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1838 aligncenter\" src=\"https:\/\/simplyblended.com\/wp-content\/uploads\/2021\/11\/REJUVANESSENCE11-150x150-1.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/simplyblended.com\/wp-content\/uploads\/2021\/11\/REJUVANESSENCE11-150x150-1.jpg 150w, https:\/\/simplyblended.com\/wp-content\/uploads\/2021\/11\/REJUVANESSENCE11-150x150-1-80x80.jpg 80w, https:\/\/simplyblended.com\/wp-content\/uploads\/2021\/11\/REJUVANESSENCE11-150x150-1-36x36.jpg 36w, https:\/\/simplyblended.com\/wp-content\/uploads\/2021\/11\/REJUVANESSENCE11-150x150-1-100x100.jpg 100w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a><\/p>\n<div class=\"everest-forms\"><div class=\"evf-container layout-two\" id=\"evf-1821\"><form id=\"evf-form-1821\" class=\"everest-form\" data-formid=\"1821\" data-ajax_submission=\"0\" data-keyboard_friendly_form=\"0\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp-json\/wp\/v2\/pages\/1823\"><div class=\"evf-field-container\"><input type=\"hidden\" id=\"_wpnonce1821\" name=\"_wpnonce1821\" value=\"efd0888329\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/1823\" \/><div class=\"evf-frontend-row\" data-row=\"row_2\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-1821-field_ATL3vuvTaE-4-container\" class=\"evf-field evf-field-first-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"ATL3vuvTaE-4\"><label class=\"evf-field-label\" for=\"evf-1821-field_ATL3vuvTaE-4\"><span class=\"evf-label\">Your First Name<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1821-field_ATL3vuvTaE-4\" class=\"input-text\" name=\"everest_forms[form_fields][ATL3vuvTaE-4]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-1821-field_afJsE9odC3-5-container\" class=\"evf-field evf-field-last-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"afJsE9odC3-5\"><label class=\"evf-field-label\" for=\"evf-1821-field_afJsE9odC3-5\"><span class=\"evf-label\">Your Last Name<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1821-field_afJsE9odC3-5\" class=\"input-text\" name=\"everest_forms[form_fields][afJsE9odC3-5]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_3\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_kiUNJPOjl3-26-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"kiUNJPOjl3-26\"><label class=\"evf-field-label\" for=\"evf-1821-field_kiUNJPOjl3-26\"><span class=\"evf-label\">Date of Birth<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1821-field_kiUNJPOjl3-26\" class=\"input-text\" name=\"everest_forms[form_fields][kiUNJPOjl3-26]\" required><\/div><div id=\"evf-1821-field_TKFkPad1io-6-container\" class=\"evf-field evf-field-email form-row validate-required validate-email\" data-required-field-message=\"Please enter a valid email address.\" data-field-id=\"TKFkPad1io-6\"><label class=\"evf-field-label\" for=\"evf-1821-field_TKFkPad1io-6\"><span class=\"evf-label\">Email<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"email\" id=\"evf-1821-field_TKFkPad1io-6\" class=\"input-text\" name=\"everest_forms[form_fields][TKFkPad1io-6]\" required ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_5\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_LQiqQkAVR0-27-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"LQiqQkAVR0-27\"><label class=\"evf-field-label\" for=\"evf-1821-field_LQiqQkAVR0-27\"><span class=\"evf-label\">What is your skin type? a) Combination - oily in some places, dry or balanced in others: b) Dry - tight and uncomfortable, can be all over: c) Oily - shiny and glossy, can be all over: d) Balanced - no oily or dry patches<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_LQiqQkAVR0-27\" class=\"input-text\" name=\"everest_forms[form_fields][LQiqQkAVR0-27]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_6\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_j4xPUvqFuv-28-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"j4xPUvqFuv-28\"><label class=\"evf-field-label\" for=\"evf-1821-field_j4xPUvqFuv-28\"><span class=\"evf-label\">How sensitive is your skin? a) not at all sensitive to skincare products b) rarely sensitive to skincare products c) sometimes sensitive to skincare products d) very sensitive and prone to redness and inflammation e) unsure<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_j4xPUvqFuv-28\" class=\"input-text\" name=\"everest_forms[form_fields][j4xPUvqFuv-28]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_7\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_1JeJYzYnyp-29-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"1JeJYzYnyp-29\"><label class=\"evf-field-label\" for=\"evf-1821-field_1JeJYzYnyp-29\"><span class=\"evf-label\">What do you want your Simply Blended products to achieve for your skin?<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_1JeJYzYnyp-29\" class=\"input-text\" name=\"everest_forms[form_fields][1JeJYzYnyp-29]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_8\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_RhgNEl4GOx-11-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"RhgNEl4GOx-11\"><label class=\"evf-field-label\" for=\"evf-1821-field_RhgNEl4GOx-11\"><span class=\"evf-label\">Any diagnosed medical conditions?<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_RhgNEl4GOx-11\" class=\"input-text\" name=\"everest_forms[form_fields][RhgNEl4GOx-11]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_9\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_09gXJPbCuK-12-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"09gXJPbCuK-12\"><label class=\"evf-field-label\" for=\"evf-1821-field_09gXJPbCuK-12\"><span class=\"evf-label\">Any prescribed medication? If yes, give details of name of medication and dosage.<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_09gXJPbCuK-12\" class=\"input-text\" name=\"everest_forms[form_fields][09gXJPbCuK-12]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_10\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_FxhX6Lvtgz-13-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"FxhX6Lvtgz-13\"><label class=\"evf-field-label\" for=\"evf-1821-field_FxhX6Lvtgz-13\"><span class=\"evf-label\">Any over the counter medications regularly taken? If so, which ones and how often<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_FxhX6Lvtgz-13\" class=\"input-text\" name=\"everest_forms[form_fields][FxhX6Lvtgz-13]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_11\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_mcbQUzWtuc-14-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"mcbQUzWtuc-14\"><label class=\"evf-field-label\" for=\"evf-1821-field_mcbQUzWtuc-14\"><span class=\"evf-label\">Are you or could you be pregnant? If yes which trimester?<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_mcbQUzWtuc-14\" class=\"input-text\" name=\"everest_forms[form_fields][mcbQUzWtuc-14]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_12\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_cj2fh1wr8W-15-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"cj2fh1wr8W-15\"><label class=\"evf-field-label\" for=\"evf-1821-field_cj2fh1wr8W-15\"><span class=\"evf-label\">Are you breastfeeding?<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_cj2fh1wr8W-15\" class=\"input-text\" name=\"everest_forms[form_fields][cj2fh1wr8W-15]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_13\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_B7Ez3TzUmi-30-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"B7Ez3TzUmi-30\"><label class=\"evf-field-label\" for=\"evf-1821-field_B7Ez3TzUmi-30\"><span class=\"evf-label\">What is your current skincare regime?<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_B7Ez3TzUmi-30\" class=\"input-text\" name=\"everest_forms[form_fields][B7Ez3TzUmi-30]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_14\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_2SeJYP0Zj4-17-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"2SeJYP0Zj4-17\"><label class=\"evf-field-label\" for=\"evf-1821-field_2SeJYP0Zj4-17\"><span class=\"evf-label\">Do you have and allergies, intolerances or sensitivities? If yes please give details<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_2SeJYP0Zj4-17\" class=\"input-text\" name=\"everest_forms[form_fields][2SeJYP0Zj4-17]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_15\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_be8kwdN3Bv-31-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"be8kwdN3Bv-31\"><label class=\"evf-field-label\" for=\"evf-1821-field_be8kwdN3Bv-31\"><span class=\"evf-label\">Would you like therapeutic oils within your products?<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_be8kwdN3Bv-31\" class=\"input-text\" name=\"everest_forms[form_fields][be8kwdN3Bv-31]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_16\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_soOond3Kxh-32-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"soOond3Kxh-32\"><label class=\"evf-field-label\" for=\"evf-1821-field_soOond3Kxh-32\"><span class=\"evf-label\">If yes, which type of aroma(s) so you like? a) Floral b) Wood c) Herb d) Spice e) Citrus<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_soOond3Kxh-32\" class=\"input-text\" name=\"everest_forms[form_fields][soOond3Kxh-32]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_17\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_E1GdIoKrq3-21-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"E1GdIoKrq3-21\"><label class=\"evf-field-label\" for=\"evf-1821-field_E1GdIoKrq3-21\"><span class=\"evf-label\">Are there any aromas you love? Please list all<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_E1GdIoKrq3-21\" class=\"input-text\" name=\"everest_forms[form_fields][E1GdIoKrq3-21]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_18\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_uKzBGpe17k-22-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"uKzBGpe17k-22\"><label class=\"evf-field-label\" for=\"evf-1821-field_uKzBGpe17k-22\"><span class=\"evf-label\">Are there any aromas you dislike, please list all<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_uKzBGpe17k-22\" class=\"input-text\" name=\"everest_forms[form_fields][uKzBGpe17k-22]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_21\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-1821-field_6Ji3q5dAYl-34-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"6Ji3q5dAYl-34\"><label class=\"evf-field-label\" for=\"evf-1821-field_6Ji3q5dAYl-34\"><span class=\"evf-label\">Do you take any Vitamin A, Carotene, or Retinol supplements?<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1821-field_6Ji3q5dAYl-34\" class=\"input-text\" name=\"everest_forms[form_fields][6Ji3q5dAYl-34]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-1821-field_XB4iEz0usl-35-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"XB4iEz0usl-35\"><label class=\"evf-field-label\" for=\"evf-1821-field_XB4iEz0usl-35\"><span class=\"evf-label\">Do you use any creams or serums which contain either vitamin A, retinol or carotene<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1821-field_XB4iEz0usl-35\" class=\"input-text\" name=\"everest_forms[form_fields][XB4iEz0usl-35]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_19\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1821-field_1ctJHujZnK-23-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"1ctJHujZnK-23\"><label class=\"evf-field-label\" for=\"evf-1821-field_1ctJHujZnK-23\"><span class=\"evf-label\">Any other relevant information? please include as much detail as necessary<\/span> <\/label><input type=\"text\" id=\"evf-1821-field_1ctJHujZnK-23\" class=\"input-text\" name=\"everest_forms[form_fields][1ctJHujZnK-23]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_22\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-1821-field_H1LtErpUkt-40-container\" class=\"evf-field evf-field-checkbox form-row\" data-field-id=\"H1LtErpUkt-40\"><label class=\"evf-field-label\" for=\"evf-1821-field_H1LtErpUkt-40\"><span class=\"evf-label\">Please submit to show you are happy for Simply Blended by Sarah Bennett to safely store this information in accordance to GDPR<\/span> <\/label><ul id=\"evf-1821-field_H1LtErpUkt-40\"><li class=\"choice-1 depth-1 everest-forms-selected\"><input type=\"checkbox\" id=\"evf-1821-field_H1LtErpUkt-40_1\" class=\"input-text\" name=\"everest_forms[form_fields][H1LtErpUkt-40][]\" value=\"yes\"   checked='checked'><label class=\"everest-forms-field-label-inline\" for=\"evf-1821-field_H1LtErpUkt-40_1\">yes<\/label><\/li><\/ul><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><\/div><\/div><\/div><div class=\"evf-honeypot-container evf-field-hp\"><label for=\"evf-1821-field-hp\" class=\"evf-field-label\">Name<\/label><input type=\"text\" name=\"everest_forms[hp]\" id=\"evf-1821-field-hp\" class=\"input-text\"><\/div><div class=\"evf-submit-container \" ><input type=\"hidden\" name=\"everest_forms[id]\" value=\"1821\"><input type=\"hidden\" name=\"everest_forms[author]\" value=\"2\"><button type='submit' name='everest_forms[submit]' class='everest-forms-submit-button button evf-submit ' id='evf-submit-1821' value='evf-submit' data-process-text=\"Processing\u2026\" conditional_rules='&quot;&quot;' conditional_id='evf-submit-1821'  id=\"evf-submit-1821\" aria-live=\"assertive\">Submit<\/button><\/div><\/form><\/div><!-- .evf-container --><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - 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