Stephenie Koons Beauty
SKINCARE QUIZ
Welcome! I am excited to work with you and learn more about you and your skin! Once I have your responses, I can give you a personalized skin care ritual with the best products for your concerns and needs. Please allow up to 36 hours for a response.
Name
*
First Name
Last Name
Phone Number
*
Results will be sent via text message.
Format: (000) 000-0000.
Email
*
example@example.com
How would you describe your skin?
Dry
Neutral/Normal
Combination
Oily
Not sure
After you wash your face it feels:
Tight or Dry
No particular sensation
Slight sheen
Oily
None of the above
How does your skin feel a few hours after using moisturizer?
Dry
Oily
Dry in some area and oily in others
I don't use moisturizer
None of the above
What are your skin goals? (check all that apply)
Hydration
Better, healthier skin
Glowing skin!
All of the above
I’m not sure I need help!
Other
What are your face and/or body skin concerns (check all that apply)
Sensitivity
Redness
Fine lines or wrinkles
Loss of firmness or elasticity
Hyperpigmentation
Acne
Dryness
Rosacea
Dull Skin
Eczema (on face)
Stretch Marks
Eczema (on body including scalp)
Psoriasis (on body including scalp)
Dry/Cracked Lips
Cold Sores/Fever Blisters
Scarring (acne, surgical etc.)
Other
What is your age range?
*
20 or below
21-35
36-50
51-65
66 or older
Do you wear make-up?
Please Select
Yes
No
Do you have a current skincare ritual?
Please Select
Yes
Somewhat
No
If you answered "Yes or Somewhat" to the question above, what does it consist of? (Check all that apply)
Cleanser
Toner
Serum
Sunscreen or moisturizer with SPF
Moisturizer without SPF or face oil
Eye Cream
Retinol or Retin-A
Exfoliant
Other
Are you looking to replace your current skincare routine?
Please Select
Yes
No,just adding on
Possibly
Are you allergic to any skincare ingredients (If Yes, please list them below)
blanks
Please select below any other items you are interested in receiving info on.
Body care
Hair care
Mens beard care
Makeup
Lash serum
Questions or comments?
blanks
Submit
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