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Skin Quiz
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10
Questions
START
HIPAA
Compliance
1
What is your gender?
*
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Male
Female
Prefer not to say
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2
How old are you?
*
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20-25
26-35
36-45
46-55
56-65
66+
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3
Are you currently pregnant or nursing?
*
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YES
NO
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4
What is your number one skin concern?
*
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Normal: Your skin maintains a healthy balance, neither too dry nor too oily, with smaller pores and minimal breakouts
Oily: Your skin appears shiny throughout the day, often requiring blotting, and may have larger pores.
Dry: Your skin feels tight, flaky, or scaly, necessitating frequent moisturization.
Combo: Some areas feel dry while others are oily, commonly experiencing oiliness in the T-zone.
Sensitive: Introducing new products often leads to breakouts, and your skin is easily irritated.
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5
Does your skin easily become red, flushed, or feel warm to the touch?
*
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Yes - My skin can remain red for extended periods and/or is susceptible to rosacea.
Yes - My skin becomes red after a shower, exercise, or using specific products but the redness doesn't persist.
No - This is typically not a concern for me.
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6
How frequently do you encounter breakouts?
*
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Never
Rarely (1-2 times per month)
Occasionally (3-4 times per month)
Often (multiple new breakouts per week)
All the time (new breakouts daily)
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7
What is your main skin goal?
*
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Brighten — addressing unwanted pigment, redness, or dullness.
Breakouts — managing existing breakouts and preventing future ones.
Anti-Aging — improving fine lines, wrinkles, and addressing sunspots or pigment.
Texture/Tone — achieving smoother, more even skin.
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8
Name
*
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First Name
Last Name
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9
Email
*
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example@example.com
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10
Phone Number
*
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Please enter a valid phone number.
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