TBSAH Skin Care Questionnaire

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Welcome

Hi Beautiful! To help me learn more about your skin care concerns, please take a few minutes to complete this skin care questionnaire so that I can suggest products tailored to your specific needs.

16Questions

1
Name* This field is required.Hello beautiful, what's your name?
First Name
Last Name
2
Phone Number* This field is required.Please provide me with your mobile phone number for text follow-up
3
Email* This field is required.
example@example.com
4
Let me know who referred you so I can thank them!Provide the name of the person who referred you or the hostess name.
5
Rate Your Current Skin Care Routine* This field is required.On a scale of 1 - 5 with 5 being the best, and 1 being the worst, select how happy you are with your current skin care routine.
HATE IT (I need help!)
LOVE IT
6
Tell me a little about your current skin care routine:* This field is required.What products/brands are you using? How often do you use them?
Huge
Large
Normal
Small
Ok
Ok
7
What is your age range?* This field is required.
Teens
20s
30s
40s
50s
60s+
8
Select the ONE statement that best describes your current skin care needs:* This field is required.
I want a simple, healthy skin care regimen and/or have sensitive skin.
I have early-to-moderate signs of aging and would like to diminish future signs.
I have advanced signs of aging and would like to diminish future signs.
I have mild-to-moderate acne blemishes I would like to address
9
Select the ONE statement that most closely describes your skin care type:* This field is required.
Dry
Normal
Combination (T-Zone)
Oily
I'm not sure?
10
FACE: Tell me your concerns* This field is required.Select all that apply.
Fine or expression lines
Dull skin / lack of clarity
Deep wrinkles
Dry skin
Age spots / sun damage
Oily skin
Large Pores
Black heads / clogged pores
Acne
Sensitive skin (redness, burning)
Dry lips
11
EYES: Tell me your concerns* This field is required.Select all that apply.
Puffiness / Dark circles
Fine lines and wrinkles
Loss of firmness and elasticity
Dryness
12
Body: Tell me your concerns* This field is required.Select all that apply.
Acne
Sun Damage
Dry skin
Cracked heels
Cellulite
13
I'm interested in learning more about:* This field is required.Select all that apply.
Additional skin care options
Makeup
Hair Care
Hands & Feet Care
Body & Massage Oils
Spa Treatments
Men's Body Care
Fragrance and body care
Earning extra money
Gift giving/ideas
Earning hostess rewards
14
What is your beauty budget?* This field is required.Tell me how much you'd like to spend every 2-3 months on your skin care routine.
$49 or less
$50 - $100
$100+
15
Let's get social!* This field is required.I primarily use Facebook Messenger for my consultations. If you're on Facebook, please provide your FB profile link, user name and/or your name as it's displayed on Facebook to make it easier to connect with you as I will be sending you a friends request and a private message via messenger. If you're not on Facebook, provide your preferred method of contact below.
Facebook.com/yourusername
16
Other / MessageTell me if there is any other important information you think I should know about your skin care concerns (i.e. certain medications and interactions, pre-existing skin care conditions, allergies to certain ingredients, etc.)
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Large
Normal
Small
Ok
Ok
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