Personal beauty questionaire
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Personal beauty questionaire

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Check out my personal Beauty questionaire.

Check out my personal Beauty questionaire.

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    Personal beauty questionaire Personal beauty questionaire Document Transcript

    • Representative ID:________Receive a Personalized Skin Care Recommendation from Deborah HunterCreate Your Beauty Profile TodayName (please print): ____________________________________________Address: ______________________________________________________City: ______________________________ State: ______ ZIP: __________Phone – Work: _____________________ Other: ______________________What is the best way to contact you? (Circle one)Email Phone VisitBirthday: __/__ (mm/dd)Skin ProfileAge (circle one) Under 25 26-35 36-45 Over 45Skin Type (circle one)Dry Normal Normal plus oily T-Zone OilyFace: Skin Concerns (circle all that apply)None Dull Skin Uneven skin tone or blotchiness Enlarged facial poresAge spots on the face Deep creases (Forehead or crow’s feet)Fine lines and wrinkles around eyes Dark circles under eyesLips (Fine lines, dry, lipstick feathering) Sagging facial skinLoss of firmness / elasticitySkin Conditions (circle all that apply)None Sensitive Skin Rosacea Adult acne HyperpigmentationBroken capillariesAllergies (circle all that apply)None Fragrance Fruits: Tropical Fruits: Citrus Lanolins NutsHand & Body: Concerns (circle all that apply)Cellulite Loose abdominal skin or sagging buttocks Age spots on handsBreast stretch marks or sagging Stretch marksCurrent Skin Care Regimen
    • Do you currently use:Toner: yes / no Separate Night: yes / noExfoliant: yes / no Moisturizer: yes / no Daily UV: yes / noWhich best describes your product usage?Prefer to use a minimal amount of products, and would like to see a Basicproduct regimen of 3 products.Would like to see a Complete product regimen of all products and treatmentsmost appropriate.Which of the following are important when deciding which Skin Careproducts to use? (circle all that apply)Natural Ingredients Anti-aging benefits Beautiful packagingCutting-edge technology Products for my skin typeAt-home dermatological treatments Representative ID: _________