Skincare Questionnaire
Please fill this out to the best of your knowledge.
Today's Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Social media handle
*
@example
What is your age range?
*
20's
30's
40's
50's+
Which of the following statements applies to you best?
*
I have oily skin
I have acne
I have dry and dull skin
I have an uneven skin tone
I have wrinkles
I have pigmentation
I suffer from redness and sensitivity
I have a combination skin
I have brown spots from sun damages
Other
How important is having healthy skin to you?
*
Not at all
1
2
3
4
Very
5
1 is Not at all, 5 is Very
Which skincare products do you currently use?
*
Makeup remover
Cleanser
Toner/Toning Pads
Eye Cream
Serum
VItamin C
Retinol
AM Moisturizer
PM Moisturizer
Sunscreen
Other
How often do you buy skincare products?
*
Rarely
1
2
3
4
Very often
5
1 is Rarely, 5 is Very often
Where do you purchase your skin care products?
*
Amazon
Target/Walmart
Ulta/Sephora
Department stores
Influencers
Spa/Salon/Dermatologist office
Other
Please indicate how much you spend on skincare products on a monthly basis on average.
*
Do you treat your skin to an exfoliator or facial scrub 1-3 times EVERY week?
*
Yes
No
Do you treat your skin to a face mask 1-3 times EVERY week?
*
Yes
No
Please tell me which product(s) you want to get more information about or how I can help you?
Submit
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