Survey Maker Survey Templates Contact Privacy & Security

Clean Skincare Questionnaire: Find the perfect products for YOUR skin!

Full Name

Select the option that best describes 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)

Acne prone

Other

Please Specify:

Choose your biggest skin concern:

Active Acne, Acne scars from historic acne

Dryness, Dullness, Sensitive Skin, Large Pores, Age Prevention

Oily Skin

Aging Skin, Fine lines/ wrinkles, Skin Spots or Discoloration, Puffiness, or Redness or uneven skin tones

Other

Please Specify:

If you have had a reaction to skincare products in the past, please tell me more about which product(s) you reacted to and what type of symptoms you experienced.

What does your current skincare routine consist of? Please include the following information: Product and brand name, time of day used (i.e. Morning or night), list products in order of application.

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

Less than $50

$50-$100

$100-200

$200 or more

I'm open to whatever I need

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

Yes

Awesome! Please tell me a little bit about which products you currently use and would be interested in replacing with safer options.

Please list any other concerns or question you might have here I am happy to support you any way that I can!

{"name":"Clean Skincare Questionnaire: Find the perfect products for YOUR skin!", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full Name, Email, Select the option that best describes your skin type:","img":"https://cdn.poll-maker.com/31-1088666/beautycounter-allure-pic.jpg?sz=1200-00110006980989005300"}