Beautycounter Skincare Consultation
Thank you for taking the time to fill out this questionnaire! It will help me make the best recommendations for your skin.~Melissa
First & Last Name:
What do you think your skin type is?
Normal (no or few blemishes, balanced, etc.)
Oily (dull or shiny complexion, blackheads and breakouts more common, large pores 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, itchy, burning common)
Do you have any of the following skin concerns? Check as many as apply:
acne scars from historic acne
general overproduction of oil
dark spots, hyperpigmentation, melasma, or discoloration
ezcema or dermatitis
redness or uneven skin tone
a known reaction to skin products
If you had a reaction to skin care products before, please tell me more about what products and what symptoms you exhibited. Please also list any known ingredient allergies:
What does your current skincare routine consist of? (Please list when you use them, i.e. morning or night, order of application, and the brand name)
Do you have a budget in mind for your initial order? If so, what range would you like to stay in? (I will provide you with a few different options that will allow you to pick and choose products to stay within budget!)
Less than $50
$200 or more
I'm open, depending on what's needed
Are you interested in hearing about our cosmetic line and recommendations on product?
No, not at this time
If yes to above, please tell me a little bit about which products you currently use and would be interested in replacing with safer options:
Please list any concerns or questions you may have here! I am happy to lend as much support as I can, and helping you find the perfect products to give you your dream-skin is my passion!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service