Skincare Quiz

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Name
First Name
Last Name
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Email Address* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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1. What is your age range?* This field is required.
20's
30's
40's
50's+
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2. What are your main concerns about your skin?* This field is required.
Acne
Preventing signs of aging
Pores
Dark spots/Pigmentation
Dullness
Wrinkles/Fine Lines
Dark Circles
Redness
Irritation
Excessive Dryness
Excessive Oil
Loss of elasticity
Uneven skin tone
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Add any additional concerns
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3. Have you ever been treated by an aesthetician or dermatologist for these concerns?* This field is required.
Yes
No
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If yes, please elaborateHave you ever been treated by an aesthetician or dermatologist for these concerns?
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4. What type of skin do you have?* This field is required.
Oily
Dry
Combination
Balanced
No idea
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5. How often do you feel that your skin is sensitive?* This field is required.
Never
Rarely
Sometimes
Always
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6. Are you allergic or have you ever had a reaction to any skincare products, plants, fruits, etc.?* This field is required.
Yes
No
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If yes, please explain Are you allergic or have you ever had a reaction to any skincare products, plants, fruits, etc.?
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7. Do you experience any of the following medical conditions?* This field is required.
Asthma
Eczema
Allergies
Rosacea
None
Other
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List all medications you currently take - write none, if none
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8. How much time do you spend in front of electronic devices per day?* This field is required.
Less than 1 hour
1-3 hours
3-6 hours
6-10 hours
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9. What type of weather do you experience where you live?* This field is required.
Sunny & Tropical
City dweller
Cold winters & mild summers
Dry & hot desert
Cold & dry year-round
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10. How often do you workout?* This field is required.
Never
1-2 times a week
3-5 times a week
6-7 times a week
2x times a day
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11. How much time do you spend to take care of your skin per day?* This field is required.
Less than a minute
A few minutes
Around 5 minutes
More than 7 minutes
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12. How do you wash your face?* This field is required.
Just water
Water and a foaming cleanser
Water and an oil based cleanser
Other
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13. Have you ever been prescribed accutane?* This field is required.
Yes, I am currently using accutane
Yes, but I stopped less than a year ago
Yes, but I stopped over a year ago
No, I have never used accutane
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14. Do you use a vitamin A derivative such as retinol, retinal, tretinoin, adapalene, retinoic acid etc.* This field is required.
Yes
No, but I have in the past 3 months
No
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If yes, please elaborate in detailDo you use a vitamin A derivative such as retinol, retinal, tretinoin, adapalene, retinoic acid etc.
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15. List all products you currently use on a consistent basis, in the order you use them* This field is required.
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16. How dedicated are you to starting and continuing a full skincare home routine* This field is required.
I want to see results, but want to keep my routine as simple as possible,
Very dedicated and will use whatever it takes
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17. How many steps are you open to doing in the morning and night?* This field is required.
2-3
3-5
5+
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18. What is your preferred product budget? Please note that a FULL step homecare routine with professional product typically starts at a minimum of $150* This field is required.
Under $125
$125-$175
$175-$250
$250+
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19. Are you currently pregnant or breastfeeding?* This field is required.
YESNO
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20. Please upload photos of your bare skin in bright lighting. Front facing, left facing, right facing.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Photos are optional but preferred
Cancelof
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By checking the box below and signing, I confirm that I have read and understood this agreement in full. I agree to all terms stated above. I consent to receive skincare recommendations based on the information I provided
I agree
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I confirm I am of 18 years of age or older
I agree
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Signature
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