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Clean Skin Care Questionnaire
Ready for a clean skin care routine?! Fill out this quick questionnaire & I'll get back to you with Beautycounter recommendations specific to your skin type!
Thank you!
Paulina
www.paulinacomesclean.com/
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Email
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Your email
1. Your name.
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Your answer
2. How old are you?
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under 18
18-24
25-29
30-34
35-45
45+
How would you describe your skin type?
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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)
Other:
4A. What is your primary skin concern?
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acne / on-going blemishes/ oily
aging skin
no major concerns - I just want safer products
Other:
4B. What are your secondary skin concerns? (check top 3 concerns)
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dullness
large pores
redness
uneven skin tone / discoloration
fine lines / wrinkles
acne scaring
eczema
sensitive
dark under eye circles
Other:
Required
5. If you have had a reaction to any skin care products before, please tell me more about what products and what happened.
Your answer
6. What does your current skincare routine consist of? (Please list the brand/company and what you like / dislike)
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Your answer
7. Do you have a budget in mind? If so, what range would you like to stay within to get started?
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Less than $50
$50-$100
$100-$200
$200 or more
I am open --depending on what's needed
8. Are you interested in hearing about our makeup line & recommendations on products?
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Yes
No, not right now
9. If interested in cosmetics, please tell me a little bit about which products you currently use & would be interested in replacing with safer options.
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Your answer
10. Are you interested in the consultant aspect of Beautycounter?
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Yes, I would love to learn more!
No, not right now.
Maybe! I've gotta think about it.
Please list any other concerns or questions you might have here. Happy to help! :)
Your answer
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