Skincare and Makeup Survey
Who's Interested? (Full Name)
Select the option that best describes your skin type
Normal (no or few blemishes, balanced, etc.)
Dry (dull or rough complexion, irritation common, flaky)
Combination (areas of both dry and oily skin, usually along the forehead nose and chin)
Sensitive (does not tolerate many products well, redness, irritation, itchy, burning common)
Acne prone skin
Do you have any of the following concerns? Check as many as apply to you.
Acne scars from historic acne
General overproduction of oil
Skin spots or discoloration
Eczema or dermatitis
A known reaction to skincare products
Redness or uneven skin tones
If you have had a reaction to skincare products in the past, please tell me more about which product(s) you reacted to and what type of symptoms you experienced.
Do you have a budget in mind? If so, what range would you like to stay in to get started?
Less than $50
$200 or more
I’m open, depending on what is needed.
Are you interested in hearing about our makeup products and receiving recommendations?
Not Right Now
If you are interested in cosmetics, please tell me a little bit about which products you currently use and would be interested in replacing with safer options.
Please list any other questions or concerns that you might have here. I am happy to support you any way that I can. Thank you!
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