Safer Skin Care Consultation Form
It's time to clean up that beauty routine!
You do not have to sacrifice your health in the name of beauty. Beautycounter creates safer, high performance products that are not only chic on your counter, but improve your skin and provide a look that will help you feel confident and beautiful every day.
I'm so excited to help you design a routine and plan you love!
After completing the form, you will be emailed with product recommendations. If you'd like to schedule a FREE 30 minute skin care chat we can do that too.
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Name (First & Last)
What would you consider your skin type?
Normal (little to no concerns, balanced, ect)
Oily (dull or shiny complexion, blackheads and/or breakouts, large pores)
Dry (dull or rough complexion, irritation common, flaky)
Combination (areas of both dry and oily usually along forehead, nose, and/or chin)
Sensitive (does not tolerate many products well, redness, irritation, itchy, burning)
Do you have any of the following skin concerns? (Check all that apply)
Eczema or dermatitis
Known reaction to skin products
Over production of oil
Redness or uneven skin tone
Skin pots or discolouration
If you selected acne, please provide more details (pimples/white heads or cysts; frequency of breakouts; typical healing time; location on face; hormone related; etc.)
What are your skin care routine preferences?
Robust day & night routine with weekly treatments
Please describe your current MORNING skin care routine. Please Include order of application and brands of products.
Please describe your current EVENING skin care routine. Please Include order of application and brands of products.
What products are you currently looking to replace and/or add to your skincare routine?
Are you interested in our cosmetics and recommendations?
Not right now
What products are you currently looking to replace and/or add to your cosmetic routine? Feel free to share current cosmetic products and brands.
Do you have a budget in mind? If so, which range would feel most comfortable? (Keep in mind, I will provide you ALL the recommendations I think your skin needs - possibly for future orders, but I will star top suggestions based on your budget.)
Less than $50
I am open, depending on what is suggested
Include any other skin details here:
Let's connect more! Tell me something special about you... where you live, what your hobbies are, what you are passionate about, how did we connect... whatever you'd like to share!
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