Skin Quiz

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Skin Quiz

For a custom skin care regimen, please fill out the below questionnaire:

What is your name? *

What is your email address? *

What is your phone number? *

What is your preferred form of contact? *

Text Message

Phone Call / FaceTime

How old are you? *

Under 18

18 - 24

25 - 34

35 - 44

45 - 54

55+

What is your gender? *

Male

Female

Other

Prefer not to say

How would you describe your skin type? *

Oily - skin appears shiny & pores are very visible

Normal - skin is neither dry, nor oily, or sensitive

Combination - skin feels dry or normal in some areas, and oily in others (nose, chin, forehead)

Dry - skin feels dry and tight, and pores are not visible

Sensitive - skin is delicate and responsive to changes

What is your primary skin concern? *

Fine lines and wrinkles

Dullness and lack of radiance

Dryness and dehydration

Texture and blemishes

Enlarged pores and oiliness

Uneven skin tone and dark spots

What is your main skin goal? *

Bright, radiant skin

Clear, even skin tone

Replenished, hydrated skin

Plump, tight skin

Smooth, refined skin

Do you wear makeup? *

Yes

Occasionally

Any other details or comment you feel would be helpful - ex: medications, underlying health issues, allergies, etc... *

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