Skincare Consultation Form
Howdy! So that I can determine the products or regimen that will have your skin looking and feeling it's best, please answer the following quick questions. Based on your answers, I'll be able to make recommendations for your skin type or for any issues you might have. You can expect to hear back from me within 48 hours of submitting your answers.
Thanks for trusting me! I look forward to helping you find the products you love.
First and last name
How do you describe your skin type?
Combination (areas of both dry and oily skin; oily common around forehead, nose, and chin)
Oily (dull or shiny complexion, blackhead and breakouts commons, large pores common)
Sensitive (often does not tolerate products well, irritation, redness, itchy, burning common)
Dry (dull or rough complexion, flakey, irritation common)
Normal (few to no blemishes, balanced, etc)
Do you have any of the following skin concerns? Please check as many as apply.
Dryness or dullness
Redness or uneven skin tone
Fine lines or wrinkles
Eczema or dermatitis
Overall oil overproduction
Skin spots or discoloration
Have you had any adverse reactions to products in the past? If so, please tell me about it, including the products used.
What is your current skincare routine? Please list morning versus evening, the order of application, brands, et cetera.
How much are you wanting to spend to get started?
Less than US$50
Between US$50 and $125
US$125 or more
I'm flexible based on product recommendations
Are you interested in hearing more about Beautycounter cosmetics?
Not at this time.
If yes, please share a little about what you currently use and which products you are considering replacing with a safer option(s).
Any other comments or concerns you want to share. I'm here to help! 💕
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