Anna's Skincare Questionnaire

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So glad you found me and are excited to switch to safer skincare! :-)

Fill this out and I will get back to you with personalized recommendations!

Please note the recommendations I will give you are primarily from Beautycounter, Crunchi, Pure Haven, and other US/Canada brands. I am not very familiar with brands from Europe or Australia/NZ, or other locations, and cannot help. Be sure to join my Clean Living & Green Eating for Fertility Facebook group which has women from all over the world who can help you find products that will work for you! And join us at my Non-Toxic Beauty Facebook Group as well!

-> Clean Eating & Green Living for Fertility

-> Non-Toxic Beauty with Anna Rapp

* Required

Email *

Do you live in the U.S. or Canada? I can't make recommendations for regions outside this area.

Yes, I live in the U.S., or Canada

No, I live somewhere else

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Your Name: *

How old are you?

Under 18

18-24

24-30

30-35

36-45

45+

Clear selection

What products are you specifically interested?

EVERYTHING!

Skin Care

Make Up

Deodorant

Other:

Do you have any known allergies to ingredients that might be in skin care that I need to know about?

Soy

Almonds

Gluten

Shea

Coconut

Cocoa

Argan

Marula

Other:

Are you a vegan who avoids all animal products, including cruelty-free derived lanolin, beeswax, and honey?

Yes

Other:

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What would you consider to be your skin type? *

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)

Required

Primary Skin Concerns *

Active acne

Acne scars from earlier in life

Hormonal Acne only

Dryness

Dullness

Overproduction of oil

Fine Lines or Wrinkles

Aging Skin

Sun spots or Discloration

Eczema or Dermatitis

A known reaction to skin products

Redness or uneven skin tone

Large pores

Rosacea

Other:

Required

Secondary Skin Concerns *

Active acne

Acne scars from earlier in life

Hormonal Acne only

Dryness

Dullness

Overproduction of oil

Fine Lines or Wrinkles

Aging Skin

Sun spots or Discloration

Eczema or Dermatitis

A known reaction to skin products

Redness or uneven skin tone

Large pores

Rosacea

Other:

Required

If you have had a reaction to skin care products before, please tell me more about what products and what symptoms you exhibited?

What does your current skincare routine consist of? (Please list when you use them i.e. morning or night, the order of application, and the brand/company) *

Do you have a budget in mind? If so, what range would you like to stay in to get started? *

Less than $100

$100-$200

$200-$300

I'm open

If you are interested in makeup, please tell me a little but about which products you use now and would be interested in replacing with safer options! *

Do you have any other concerns or questions?

Are you interested in learning more about the safer skincare and beauty business opportunity with Beautycounter?

Yes, please tell me more!

Maybe in the future, but not right now.

No, thanks!

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