Skincare & Beauty Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

For the best consultation, before we get started I need to know a few things. Please answer the following questions and let's get started! XOXO

Name (First & Last): *

Email Address: *

Mailing Address (To Send Samples): *

Cell Number (For Texting Only) I like to text my clients about promos and incentives. Would you like to be added to my client texting service? If so, please leave your name and cell number. Promise not to bug you.: *

What is your skin type? *

Sensitive (allergy prone skin, redness, irritates easily)

Dry (additional moisture required)

Normal To Dry (normal t-zone & dry cheeks)

Normal

Normal To Oily (normal cheeks & oily prone t-zone)

Oily (Prone to breakouts)

Other (Explain:)

Other:

What are your skin concerns? Check all that apply. *

Dry (Dull, flaky, make up doesn't wear long)

Oily (Shiny, greasy, acne prone, make up doesn't wear long)

Sun Spots & Aging (Brown spots, fine lines, elasticity concerns)

Combination (Occasional breakout, weather reactive)

Normal

Other:

What is your current skincare practice? *

I have a complete morning and night routine. I LOVE skincare products!

I'd like to have a morning or night routine.

I'd like to spend as little time in the bathroom as I can.

I'm interested in switching my body products (shampoo, conditioner, body lotion, body oil, etc).

I'd like to learn more about baby and kids products.

I'd like to learn more about sunscreen products.

Other:

What is your current beauty routine? *

Foundation, powder, brows, eyes, checks, lips. I reapply if I need to.

SPF Tint, mascara, and maybe lips. Don't reapply for the rest of the day.

I stop at skincare. No make up. I apply sunscreen. Maybe lip balm. Simple.

What's your budget? *

No price budget. I need a new safer beauty routine? Morning and night. Skincare and beauty.

I'd like to make the switch to safer BUT let's start with a few products?

I have a budget. Saving for a laundry list of things. Skincare a priority. Please suggest.

I have a budget. But make up is my priority. My color is toxic. Need to switch.

Other

Required

Any additional information about your skincare and beauty routine you'd like to add? *

Any concerns, allergies, additional information, etc.? *

Birthday (month & day ONLY): *

Husband, wife, partner, etc name (first & last):

Email Address (husband, wife, partner, etc.):

If you are completing this form prior to a Pop Up? Please note host name & date of Pop Up.

Would you like to "Host A Pop Up" to earn Host Rewards? Earn up to five FREE products & five products at 50% Off. What day and time would you like to host? Zoom Video Calls Available. Let's chat.

YYYY

Time

To subscribe to monthly newsletter regarding new products, promotions, Pop Up calendar, and updates, please provide your email address.

Thank you for your time. I'll be in touch within 24-48 hours. I look forward to connecting with you. XOXO, Novelyn

Beautycounter : The Movement

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms