Clean Skincare & Beauty Questionnaire

Hi friends! I know switching to cleaner & safer products can be overwhelming, but I am here to help!

I'll also add you to my Clean Beauty email list where you'll get insider tips, tricks and early access to specials and promotions (no spam, I promise!). Helping people is my passion and my goal is to educate and empower you to find better, cleaner options that work for your skin and your life.

Email address *

Name

Your answer

Age (This helps me find the right products for you)

Your answer

Are you interest in a "Cleaner Living" Consultation?

I have different types of consultations that can help you make the switch to safer products! I do all the work and you just tell me what your "clean" goals are!

Yes, please tell me more!

Not right now

What are your current skincare goals? Any issues you're currently having that you want to fix?

Your answer

What are your current skin concerns?

Dryness

Oiliness

Combination (oily & dry)

Dullness

Hormonal acne (typically very stubborn cystic acne around your chin/cheek area)

Consistent, non-hormonal acne (whiteheads/blackheads)

Occasional Breakouts

Fine Lines / Anti-Aging

Other:

After you wash your face, what happens?

My skin feels hydrated. If I didn't follow up with moisturizer right away, my skin probably would still feel hydrated 30 minutes later. I don't have issues with oiliness later in the day.

My skin feels OK and/or tight but then will get very oily later in the day.

My skin feels immediately tight after I dry my face off and I have issues with dryness later in the day as well.

My skin is quickly oily again.

If you've ever had a reaction to a skincare product, what was it and how did you react?

Your answer

What does your current skincare routine look like? Are you happy with it? What are you looking to switch out?

Your answer

Would you like recommendations for make up? If so, please list what you're looking for (and what you're currently using!) | Please be specific!

For example, if you're looking for foundation, indicate what kind, what type of coverage, etc.!

Your answer

Are you interested in becoming a Beautycounter consultant? If so, I'm happy to share more info!

No pressure AT ALL to join but I'm happy to send over more information! BC consultants get a 25% discount off of all products, 25%-35% commission on any products sold and there are never any spending requirements, order requirements, or anything like that :)

Yes, please send me info!

Maybe, tell me more!

Not right now

Other:

Please share any other questions or concerns you might have! Ask anything and everything and I'll do the best I can to help you.

Your answer

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