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Self Care Package from Genny B
Are you interested in trying out some Beautycounter? Lemme send ya some!
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Name
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Physical Address
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Your answer
Email
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Your answer
Would you like to be added to my newsletter list? (quarterly)
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Yes
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What are you interested in? pick up to 3
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Countertime - Anti Aging
Countermatch - hydration
Countercontrol - oil/breakout control
Counterman - formulated for men's skin needs (shaving, oil control, etc)
Overnight Resurfacing Peel
Sunscreen
Do you have any of the following concerns? (check as many that feel right for you)
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Cystic Acne
Acne scars from previous breakouts
Dryness
Dullness
General overproduction of oil
Fine lines/wrinkles
Aging Skin
Skin spots or discoloration
Eczema or dermatitis
A known reaction to skin care products
Redness or uneven skin tones
Large pores
Rosacea
Other
Are you currently using a topical prescprition?
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Yes
No
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