Beautycounter Skin Consultation - Well Beyond the Kitchen

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Thanks for taking a few minutes to fill out this survey...the first step on your switch to safer, and to your skin looking and feeling great.
This is the best way for me to learn about your skin and what products you're currently using, so I can customize a regimen just for you! I'm excited to get you started :)

Email *

What is your full name? *

Have you used Beautycounter before?

Yes! Loyal client

Nope, not yet!

I've tried a couple products

Clear selection

What do you consider your skin type to be? *

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 an doily skin usually along the forehead, nose, and chin)

Sensitive (does not tolerate many products well, redness, irritation, itchy, burning common)

Other:

Do you have any of the following skin concerns? (check all that apply)

Active acne

Acne scars from historic acne

Dryness

Dullness

General overproduction of oil

Fine lines/wrinkles

Aging skin

Dark spots or discoloration

Ezcema or dermatitis

Known reaction to skin products

Large pores

Other:

Have you ever experienced a reaction to a skin care product?

Yes

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If yes, please explain which ones, what the symptoms were, and what (if anything) helped relieve symptoms.

What does your current skin care routine consist of? (Please list when you use them - day or night, what order they are used in, and the brand)

What are your goals in terms of finding a new skincare regime?

Hydrate and nourish skin

Anti-aging

Clear up acne

Balance and brighten uneven skintone

Other:

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What interests you most about switching to using Beautycounter products?

Are you interested in hearing about our cosmetic line and recommendations on products?

Yes, please!

No, not at this time.

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If yes, please tell me a little bit about which products you currently use (the brand and type of product).

How often do you wear makeup?

Daily

Occasionally

Rarely, only for special occasions

Never, but I would like to start wearing it more

Clear selection

Please list any questions, comments, or extra information I should know below.

Submit

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