Clear Skin at Any AgeTM




AcneWhisperer Blog


Referral Programs



Your basic Info

Your Acne/Rosacea Profile
Please be as thorough as you can in describing the history of your acne problem, including - but not exclusive to - birth control history, medications used in the past, how long your issues have been going on, when they started, how they started, etc.


Sensitivities and Allergies

Diet and Supplements


Skin Oiliness and Dryness Levels

Your Skin Care
(please include the full names of the products you are using, NOT just the brand names)

Your Makeup
(please include the full names of the products you are using, NOT just the brand names, color names not necessary, eye and lip makeup not necessary)

Your Body Care
(please include the full names of the products you are using, NOT just the brand names)

Your Hair Care
(please include the full names of the products you are using, NOT just the brand names)

Photos (Required)
Please upload the following 5 separate photos of your clean skin (no makeup!) as described below, not just of your particular breakouts. These and future photos will help keep track of your progress. Not too far, not too close, good lighting, and clear, in original/actual sizes.

Some required fields are missing. Please review the form and submit again.

Eval by Email® Adult Acne Clearing Program

Skin Care Consultation Form

For Adult Acne and Rosacea

(So sorry, this service is only available in the United States)

Please note :  If you are under 24 years of age, your acne is still considered

teen acne.  You will receive great basic advice, but not a full evaluation or try-me packet.

Amazingly enough, email consultations work incredibly well, because then you have everything in writing with an ability to look back on all of our correspondence any time you wish, study the information at your leisure, and understand your skin problems in a far more informed way, without having to remember the details of a phone or video conversation or risk taking inaccurate notes.  

Please feel free to ask questions throughout our email correspondence.  We will be keeping in touch regularly as we get your skin clear.  You will be required to check in once a month with your skin's progress, but any questions or concerns in between are entirely welcome!

After your form is processed, you will receive a full analysis by email within 4-6 days.  Sometimes there are delays around spring and winter holiday times, but it's well worth the wait.  A Try-Me packet with full instructions will then be sent to your home, which you will test for 1-2 days.  After that, you can order right here from this web site by clicking on the Products button at the top left of this page.  You'd be shocked at how much can be accomplished this way!

Before you fill out the form below, please read the following instructions!

You must include full names of all the products you're using, not just the brand names.

Missing information, such as full address, description/history of your adult acne or rosacea, full names of products, or incorrectly taken photos,

will delay your Evaluation.

Remember, this program has a fee of $120.  If you have not paid yet, please go back to the main page and click on the Add to Cart button toward the bottom left of the page.

Careful !  DO NOT press your return key!

Pressing your return key will send the form prematurely.

Guide for required photos:

After submitting your form, please view the following links to fully understand the Eval by Email® Adult Acne Clearing Program :