Skincare + Makeup Consultation Questionnaire

Finding the right products for your skin can be tricky. Let me help you take the guesswork out of it.
Please answer the following questions to the best of your ability so I can send you personalized recommendations for Beautycounter products that are free of potentially harmful ingredients.

Beautycounter is a disruptive beauty brand that not only offers safer personal care products, but is meeting with Congress about the dangers of mainstream cosmetics. We are making moves to change regulations for the entire industry with the goal of getting safer products into the hands of everyone.

Switching to safer products doesn’t have to be overwhelming, or cost a fortune! Together, we will find what works best for your skin type and budget.

Thank you for taking the time to complete this questionnaire. I would love to help you make the switch to safer skincare enjoyable and rewarding!

Cheers to safer skincare,

Hillary
Senior Consultant, Beautycounter
Founder, Nutrition Nut on the Run

Email address *

Your Name *

Your answer

How old are you? *

Under 18

18-24

24-30

30-35

36-45

45+

What would you consider to be your skin type? *

Normal: no or few blemishes, balanced, etc.

Oily: shiny complexion, large pores, blackheads and breakouts more common

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 common

Do you have any of the following skin concerns? *

active acne

acne scars

dryness

dullness

consistent overproduction of oil

fine lines/wrinkles

aging skin

skin spots or discoloration

redness or uneven skin tone

Other:

Required

If you have had a reaction to skin care products before, please tell me more about the products and what symptoms you exhibited. *

Your answer

What does your current skincare routine consist of? Please list the products/brand, when you use them (i.e. morning or night), and the order of application. *

Your answer

Do you have a budget in mind? If so, what range would you like to stay in to get started? *

Under $50

$50-$100

$100-$150

$200 or more

I'm flexible -- depending on what is needed

Are you interested in hearing about Beautycounter's makeup line and receiving recommendations on products? *

Yes

No, not at this time

If interested in makeup, please tell me a little bit about which products you currently use and would be interested in replacing with safer alternatives. *

Your answer

Please list any other concerns or questions you might have here. Happy to help as much as I can! *

Your answer

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