Beauty Society Skin Questionnaire
Lisa LoGrasso ~ Beauty Society Advisor ~ Licensed Esthetician
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How would you like to hear from me?
*
Text
Email
How would you describe your skin?
*
Oily
Normal/Balanced
Combination
Dry
Is your skin sensitive?
*
Yes
No
Sometimes (depends on products/ingredients used - please explain in text box at the end of this survey)
Is your skin blemish prone?
*
Yes
No
Sometimes (depends on products/ingredients used - please explain in text box at the end of this survey)
How would you describe your pore size?
*
Not visible
Small, but visible
Larger throughout your T-zone
Large across your face
Skin concerns I have… (check all that apply)
*
Uneven skin tone
Acne prone
Blackheads
Acne scars
Redness
Puffy eyes
Dark circles
Fine lines
Wrinkles
Texture
Large pores
Sagging skin
Melasma (sun spots)
Rosacea
Other (describe at the end of this survey)
Products I’d like to try… (check all that apply)
*
Cleanser
Serums
Moisturizer
Night treatment
Acne treatment
Masks
Eye cream
Neck and chest repair
Anti-aging foundation
Other anti-aging makeup items we carry
I would like to know more about the quarterly beauty box! ($49 every three months for $150 worth of product to try)
*
Yes
No
Would you like to know more about our skincare supplements to fight the signs of aging from within?
*
Yes
No
Which supplements would you be interested in trying? (Check all that apply)
Infuse (hyaluronic acid water charger) powder
Vibrant skin gummies
This is not required, but if you would like, you can upload a makeup free selfie so I can see your skin.
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Is there anything you’d like to add about your skin and what concerns you’d like to address? Be as descriptive as you like, this will help me determine the best products to choose for you.
Examples: Uneven skin tone, skin that can become sensitized to certain ingredients (please specify)
How did you find me?
*
Facebook
YouTube
Instagram
Tik Toc
Friend
If you found me through a friend, who is your friend?
Click for your new skin care journey!
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