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Representative ID:________

Receive a Personalized Skin Care Recommendation from Deborah Hunter

Create Your Beauty Profile Today

Name (please print): ____________________________________________
Address: ______________________________________________________
City: ______________________________ State: ______ ZIP: __________
Phone – Work: _____________________ Other: ______________________
What is the best way to contact you? (Circle one)
Email           Phone Visit
Birthday: __/__
         (mm/dd)

Skin Profile

Age (circle one)        Under 25     26-35          36-45         Over 45
Skin Type (circle one)
Dry             Normal        Normal plus oily T-Zone             Oily
Face: Skin Concerns (circle all that apply)
None        Dull Skin    Uneven skin tone or blotchiness        Enlarged facial pores
Age spots on the face         Deep creases (Forehead or crow’s feet)
Fine lines and wrinkles around eyes           Dark circles under eyes
Lips (Fine lines, dry, lipstick feathering)       Sagging facial skin
Loss of firmness / elasticity
Skin Conditions (circle all that apply)
None        Sensitive Skin     Rosacea       Adult acne     Hyperpigmentation
Broken capillaries
Allergies (circle all that apply)
None        Fragrance     Fruits: Tropical     Fruits: Citrus    Lanolins   Nuts
Hand & Body: Concerns (circle all that apply)
Cellulite     Loose abdominal skin or sagging buttocks            Age spots on hands
Breast stretch marks or sagging          Stretch marks




Current Skin Care Regimen
Do you currently use:
Toner:       yes / no        Separate Night:     yes / no
Exfoliant:     yes / no      Moisturizer:   yes / no        Daily UV:   yes / no
Which best describes your product usage?
Prefer to use a minimal amount of products, and would like to see a Basic
product regimen of 3 products.
Would like to see a Complete product regimen of all products and treatments
most appropriate.
Which of the following are important when deciding which Skin Care
products to use? (circle all that apply)
Natural Ingredients       Anti-aging benefits    Beautiful packaging
Cutting-edge technology        Products for my skin type
At-home dermatological treatments

                                                Representative ID: _________

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Personal beauty questionaire

  • 1. Representative ID:________ Receive a Personalized Skin Care Recommendation from Deborah Hunter Create Your Beauty Profile Today Name (please print): ____________________________________________ Address: ______________________________________________________ City: ______________________________ State: ______ ZIP: __________ Phone – Work: _____________________ Other: ______________________ What is the best way to contact you? (Circle one) Email Phone Visit Birthday: __/__ (mm/dd) Skin Profile Age (circle one) Under 25 26-35 36-45 Over 45 Skin Type (circle one) Dry Normal Normal plus oily T-Zone Oily Face: Skin Concerns (circle all that apply) None Dull Skin Uneven skin tone or blotchiness Enlarged facial pores Age spots on the face Deep creases (Forehead or crow’s feet) Fine lines and wrinkles around eyes Dark circles under eyes Lips (Fine lines, dry, lipstick feathering) Sagging facial skin Loss of firmness / elasticity Skin Conditions (circle all that apply) None Sensitive Skin Rosacea Adult acne Hyperpigmentation Broken capillaries Allergies (circle all that apply) None Fragrance Fruits: Tropical Fruits: Citrus Lanolins Nuts Hand & Body: Concerns (circle all that apply) Cellulite Loose abdominal skin or sagging buttocks Age spots on hands Breast stretch marks or sagging Stretch marks Current Skin Care Regimen
  • 2. Do you currently use: Toner: yes / no Separate Night: yes / no Exfoliant: yes / no Moisturizer: yes / no Daily UV: yes / no Which best describes your product usage? Prefer to use a minimal amount of products, and would like to see a Basic product regimen of 3 products. Would like to see a Complete product regimen of all products and treatments most appropriate. Which of the following are important when deciding which Skin Care products to use? (circle all that apply) Natural Ingredients Anti-aging benefits Beautiful packaging Cutting-edge technology Products for my skin type At-home dermatological treatments Representative ID: _________