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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.
20
Questions
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1
Name
*
This field is required.
Hello beautiful, what's your name?
First Name
Last Name
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2
Phone Number
*
This field is required.
Please provide me with your mobile phone number for text follow-up
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3
Email
*
This field is required.
example@example.com
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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.
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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.
1
2
3
4
5
HATE IT (I need help!)
LOVE IT
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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?
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7
What is your age range?
*
This field is required.
Teens
20s
30s
40s
50s
60s+
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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
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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?
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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
Other
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11
FACE: How often do you wear makeup
*
This field is required.
Everyday
Sometimes (1-2x per week)
Seldom (only on special occasions)
Never
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12
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
None
Other
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13
Body: Tell me your concerns
*
This field is required.
Select all that apply.
Acne
Sun Damage
Dry skin
Cracked heels
Cellulite
None
Other
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14
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
Baby Care
Fragrance and body care
Gift giving/ideas
Earning extra income
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15
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+
$49 or less
$50 - $100
$100+
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16
Would you be interested in a virtual facial or consultation?
*
This field is required.
Yes, tell me more
Not at this time
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17
Other / Message
Tell 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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18
Would you like to earn free products?
*
This field is required.
Would you like to earn free products by hosting a virtual Beauty Social with your friends on Facebook Messenger, Text/SMS or WhatsApp Group?
Please Select
Yes!
Maybe, tell me more
Not right now
Please Select
Please Select
Yes!
Maybe, tell me more
Not right now
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19
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
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20
Would you like to receive my monthly newsletter?
*
This field is required.
This allows me to add you to our monthly mailings sent by the company!
Yes! Sign me up!
Maybe later
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