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
Manager, Beautycounter
Founder, Nutrition Nut on the Run

Email address *

Full Name *

Your answer

May I email you about safer skincare education, new Beautycounter product launches, and special deals?

Yes

How old are you? *

Under 18

18-24

24-30

30-35

36-45

45+

Select the best option that best describes your skin type. *

Normal: no blemishes, not oily or overly dry

Oily: shiny complexion, tend to have clogged pores, blackheads + breakouts

Dry: flaky, dull or rough complexion, tend to have irritation

Combination: areas of both dry and oily skin usually along the forehead, nose, and chin

Sensitive: redness + irritation common, tend to be irritated by most products

Please select the concerns that apply to you and that you’d like to address. *

active acne

hyperpigmentation / scars from previous breakouts

dry skin

oily skin

large pores

dull complexion

fine lines + wrinkles

aging skin

sun spots / discoloration

redness / uneven skin tone

Other:

Required

Have you had a reaction to skincare or makeup products in the past? If so, please indicate which products caused this type of reaction and the symptoms you experienced. *

Your answer

What does your current skincare routine consist of? Please list in order of application, the brand name and product name. *

Your answer

What do you like about your current skincare routine? What don’t you like about it? *

Your answer

Are you interested in Beautycounter's makeup and receiving product recommendations? *

Yes please!

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

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

$150-$200

I'm flexible depending on what is needed.

Are you interested in learning about the men's skincare line, Counterman?

Yes! This would be great for the guys in my life.

Not really, just here for myself.

Are you interested in learning about starting a side business with Beautycounter?

Yes, I want to learn more!

Maybe! Gotta think about it.

No, not right now.

Do you have any additional comments, concerns or questions relating to your skincare or makeup needs? *

Your answer

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