SENSITIVE SKIN Brand Panel Study — Participant Intake Form
Answer a short set of questions to see if you’re eligible for the four-week product assessment.
Eligibility
Age range
*
Under 35
35–44
45–54
55–64
65+
Is your shipping address within the United States?
*
Yes
No
Have you tried SENSITIVE SKIN Brand products before?
*
Never
Few times
More than few times
How did you hear about this study?
*
Please Select
Instagram
Email newsletter
Friend or family referral
Skincare professional recommendation
SENSITIVE SKIN website
Other
Safety Screening
Do you have any allergies or sensitivities to any of the following: tree nuts or seed butters, essential oils, bee products, coconut, soy, other
*
Yes
No
If yes, please describe your allergies/sensitivities
Are you currently under a dermatologist's or physician's care for a skin condition, or using a prescription topical medication?
*
Yes
No
If yes, briefly describe your skin condition or prescription topical medication
Have you had a professional resurfacing or injectable procedure in the last 30 days, or do you have one scheduled during the study?
*
Yes
No
Scheduled during study
Are you currently pregnant or nursing?
*
Yes
No
Prefer not to say
Baseline Skin State
How would you describe your skin today over the past two weeks?
*
Dry
Oily
Combination
Dehydrated
Reactive
Redness-prone
Breakout-prone
Tight
Flaky
None of these
Rate how each statement applies to your skin right now
*
Rows
Not at all
Slightly
Moderately
Very much
My skin feels comfortable
My skin feels hydrated
My skin looks even in tone
My skin feels smooth to the touch
My skin looks radiant
I feel confident about how my skin looks
My skin feels sensitive
Describe your skin right now in your own words
Product History
Monthly skincare spend
*
Under $50
$50–100
$100–200
$200–400
$400+
Skincare products stopped using in the past 2 years because my skin did not tolerate them
*
0
1–2
3–5
6+
Optional: describe a product that let you down
Protocol Commitment
Describe your current skincare routine, including the products you use and the order you apply them
*
Aside from the cleanser and serum being swapped for the study, will you keep the rest of your routine the same during the study (including sunscreen and other products)?
*
Yes
No
Unsure
Do you have any planned changes in the next four weeks, including new actives, procedures, medications, or major travel?
*
Yes
No
If yes, please describe the planned changes
Can you commit to daily use for four weeks and completing a 10-minute follow-up questionnaire at the end?
*
Yes
No
Your photos help us see the real result, not just read about it.
They're reviewed internally alongside your other answers to evaluate how your skin changed over the four weeks. We won't use the photos publicly without asking you separately and getting your written consent first. Uploading photos is optional — skip it if you'd rather not, and it won't affect your participation.
Would you take an unfiltered photos of your skin at the start and end of the study in similar lighting?
*
Yes
Maybe
No
Please upload your start-of-study photos
Upload your photos
Drag and drop files here
Choose a file
Take photos at daytime, facing a window, no makeup, photographing face front, left and right sides
Cancel
of
Logistics
Email address
*
example@example.com
Ship To
*
First Name
Last Name
Shipping address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Compliance
To report an adverse reaction please contact study@sensitiveskinbrand.com
Discontinue use if irritation occurs
Consent
*
I understand I'll receive product at no cost in exchange for honest feedback, and that my responses may be used in SENSITIVE SKIN Brand's marketing and educational materials in anonymized or first-name-only form.
Consent
*
I understand this is a consumer perception study, not a clinical or medical trial, and that SENSITIVE SKIN Brand products are cosmetics.
Consent
*
I understand I will receive non-marketing emails related to this study.
Electronic Signature use
*
I agree to use electronic records and signatures
Signature/e-Signature
*
First Name
Last Name
Suffix
Date/Time Now
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
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