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Non-Toxic Beauty Skincare and Makeup Questionnaire
Helping Daughters of God transform to Non-Toxic Beauty, Body, Sex, Babies, Pets, Home & Environment. Whole Family & Home Solutions™. Allow me to help you so you longer have to suffer from toxic chemicals in your beauty regime.
Name
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First Name
Last Name
Email
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example@example.com
How old are you?
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Gen Z (Born 1997 – 2006) MUST BE 18
Gen Y or Millennials (Born 1981 – 1996)
Gen X (Born 1965 – 1980)
Boomers II or Generation Jones (Born 1955 – 1964)
Baby Boomer (Born 1946 – 1954)
Traditionalist (Silent) Generation (Born 1925 – 1945)
Greatest Generation (Born 1900 – 1924)
What would you consider to be your skin type?
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Normal (even tone and texture, blemish free, small pores, good elasticity, wellbalanced)
Oily (enlarged pores, dull or shiny complexion, blackheads, pimples, otherblemishes)
Dry or Xeroderma (dull, rough, wrinkling, sagging, flaky, itchy, small cracks, invisible pores)
Combination (dry skin at the cheek areas and oily skin at the t-zone [forehead, nose, and chin])
Sensitive (redness, itchy, burning, dryness, irritation, stinging, eczema)
What's your skin concern? Check all that apply.
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Rashes, Redness or Irritation (caused by parabens, sulfates (SLS/SLES), artificial fragrances and formaldehyde)
Acne Breakouts or Clogged Pores (results from silicones, mineral oils and petroleum based ingredients)
Burning, Stinging or Excessive Dryness (linked to alcohol based formulas, harsh exfoliants and synthetic dyes)
Eczema or Psoriasis Flare-Ups (triggered by fragrances, preservatives and sulfates)
Chronic Coughing or Wheezing (caused by aerosol sprays, talc and synthetic fragrances)
Nasal Congestion or Sinus Irritation (linked to formaldehyde, phthalates and parabens)
Asthma Flare-Ups (triggered by VOCs)
Irregular periods or Early Puberty (linked to parabens, phthalates and BPA)
Lowered Testosterone or Sperm Quality (caused by phthalates, parabens and synthetic estrogens)
Thyroid Dysfunction (impacted by triclosan and heavy metals)
Hair Thinning or Excessive Shedding (linked to sulfates, silicones and formaldehyde)
Dry, Flaky Scalp or Dandruff (caused by alcohols, sulfates and synthetic fragrances)
Brittle or Damage Hair (result from chemical-laden hair dyes, heat protectants and styling sprays)
Watery or Irritated Eyes (caused by synthetic dyes, parabens and formaldehyde)
Chapped or Peeling Lips (linked to petroleum-based lip balms, synthetic fragrances and chemical sunscreens).
Hives, Swelling or Itching (caused by latex)
Anaphylaxis (reaction to paraphenylenediamine (PPD) in hair dye, latex or synthetic fragrance)
Increased Cancer Risk (linked to parabens, formaldehyde, benzene and coal tar-based dyes)
Immune System Weakening (exposure to toxic preservatives and heavy metals).
Other
If you have had a reaction to skin care products before, please tell me more about the products and what happened.
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What does your current skin care regime consist of? (Please list the brand and what you like or dislike)
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If you have had a reaction to makeup products before, please tell me more aboutwhat products and what happened. {Let me share my personal experience I had bought some mineral makeup from AVON in 2010 and I got a chemical burn. I was trying to wash that stuff off as quickly as I could. I thought mineral makeup was good for every skin type}.
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What does your current makeup regime consist of? (Please list the brand and what you like or dislike)
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