Tiffaney Chanel Beauty
Skin Care Questionnaire - This questionnaire helps me understand your skin needs and your current routine. If a question does not apply please answer none or N/A. Please allow 24-48 hours to reply.
Sign in to Google to save your progress. Learn more
Email *
First and Last Name: *
Phone Number: *
How would you describe your skin in its normal state? *
Required
What skin concerns do you currently have that you would like to change if any? *
Required
Are there any additional skin concerns you have? *
When do you cleanse your skin? *
Required
Do you double cleanse your skin with an oil cleanser first? *
Required
If you cleanse your skin, what cleanser(s) do you use? *
How often do you exfoliate? *
Required
If you exfoliate, what do you use to exfoliate? *
Required
If you exfoliate, what is the name of the product(s) you use to exfoliate? *
What's the name of the toner you use, if any? *
How often do you use a mask? *
Required
What is the name of the serum(s) you use if any? *
Do you use a moisturizer daily? *
Required
If you use a daily moisturizer, what is the name of moisturizer? *
Please list any additional products you use. *
How often do you wear sunscreen? *
Required
If you use sunscreen, is it separate from your moisturizer or make up? *
Required
If your sunscreen is separate what is the name of it AND what is the number of sun protection strength (ie 15, 30. 50)? *
Are you currently pregnant or breast feeding? *
Required
Are you currently using and topical skin medications prescribed by your doctor/dermatologist (including prescribed Retin-A)? If so please, list. *
Are you currently using retinol (not prescribed by your doctor? if so, what is the full name brand?
Have you ever been treated for a skin condition in the past? If yes, what condition? *
Are you CURRENTLY being treated for a skin condition? If yes, what condition? *
Please list any food allergies and/or ingredient allergies: *
Please list any skin treatment products you have used that caused an unexpected reaction or side-effect? *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms