Your Proactiv Story

How did you find out about Proactiv Share Your Story? *

First Name *

Last Name *

Your Email *

Verify Your Email *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Daytime Phone Number*

Age *

Gender *

Your Story * Your story must be at least 50 characters

Upload Your Before Photo

You must be 18 years of age or older to submit a photo. If you are between the ages of 12 and 17, you can have your parents submit your photos for you. By submitting these photos, you grant Lieberman Productions (our video production partner) permission to contact you. Sorry we cannot return photos.

STEP ONE:

Attach at least one Before photo *

(3 image max, 5mb max per image, gif and jpeg only)

STEP TWO:

Attach at least one After photo * (optional, and if you already have clear skin)

(3 image max, 5mb max per image, gif and jpeg only)