Skincare Quiz

Skincare Quiz
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your Instagram Handle?*
Tell me how you found me? (I totally geek out when I see how people found my sample form *
Name 1-2 things you would change or love about your skin?*
What are some brands you use for skincare and makeup?*
1. What is your age range?*

20's30's40's50's+
2. What is your biggest concern about your skin?*

AcnePoresAgingDark spotsDullnessWrinklesDark circlesRednessOther
3. What type of skin do you have?*

OilyDryCombinationBalancedNo idea
4. How much make up do you use per day?*

NoneA littleA decent amountFull coverage
5. How often do you feel that your skin is sensitive?*

NeverRarelySometimesAlways
6. Do you feel stressed about how you look and feel?*

YesNo
7. What sentence best describes you?*

I'm new to BeautycounterI have shopped at Beautycounter with another consultant
9. What type of weather do you experience where you live?*

Sunny & TropicalCity dwellerCold winters & mild summersDry & hot desertCold & dry year-round
10. How much time do you spend to take care of your skin per day?*

Less than a minuteA few minutesAround 5 minutesMore than 7 minutes
11. How do you wash your face?*

Just waterWater and a foaming cleanserWater and an oil based cleanserOther
12. How often do you workout?*

Never1-2 times a week3-5 times a week6-7 times a week2x times a day
13. If you are interested in any of the following, please check all that apply.*

Earning products at a discount by sharing with my friendsI want to save 20% off my first order! Contact ME me at 605-291-5332 to get the promo code!!Building a business with Beautycounter to replace my present incomeSharing Beautycounter Online with my friends as a host and earning the host rewards (5 products FREE and 5 products 50% off)
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