Skin Care/Routine Questionnaire

Your skin is the largest organ of the body and absorbs everything!

Taking care of your skin and health is a task for inside the body, and out!

According to surgical dermatologist Dr. Naissan Wesley, following a skincare regimen twice a day is for maintenance of our skin health, just like we maintain the health of our teeth and gums with daily brushing.
Both non-negotiable.

All the chemicals in every product you use, the dirt and pollution in the air, the foods you eat...all enter you bloodstream on a daily basis.

They travel to your organs and affect every part of your body, especially long term! Let's see how we can help your system out!

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* 1. Please share your information below which helps with giving you pricing.

Full Name *

Instagram Handle

State/Province *

Country *

Email Address *

Phone Number *

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* 2. Who sent you this questionnaire to complete? (Please share your consultant's full name)

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* 3. What is your current age (this helps us determine your skin needs)

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* 4. Please indicate which is accurate for you

Genetically Male

Genetically Female

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* 5. Have you ever used any Arbonne products before?

Yes (Elaborate which ones)

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* 6. If you had a MAGIC WAND and could change anything about your skin, what would you like to see different?
What would your IDEAL skin look like?

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* 7. What concerns you most about your skin?
Feel free to elaborate.

Active Acne and Acne Scars

Dryness

Fine Lines/Wrinkles

Loss of firmness (loose skin)

Puffiness or Dark Circles under Eyes

Tight Feeling/Lack of Hydration

Uneven Tone or Pigmentation (including any spots, scars)

Please share anything else that may have been missed.

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* 8. Do you currently take any kind of vitamins to help your health regarding skin, (example collagen)? If so, Please elaborate which ones?

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* 9. What type of products are you currently using for your skin? (Ex. Cleanser, Toner, Mask, Moisturizer etc)

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* 10. What brands do you currently use for your skin care?

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* 11. Have you ever purchased skincare products from shops like Sephora, The Bay, Holt Renfrew, Saks 5th Avenue? If so, which store and what products?

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* 12. How would you best describe your skin type?

Normal

Dry

Oily

Combination (Dry and Oily)

Oily with Acne

Dry with Acne

Combination with Acne

Sensitive Skin (I react to EVERYTHING)

Other (please specify)

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* 13. Your skin is directly connected to your gut. What you EAT plays a huge role in the HEALTH of your skin, along with environment, hygiene and hormones.

What best describes your daily routine?

I eat VERY healthy (no gluten, sugar, dairy, or meat)

I eat moderately (a bit of everything but never over do it - once to twice a week)

I consume either dairy, gluten, sugar or meat everyday

I try to eat healthy, but my cravings get the best of me several times a week

Other (please specify)

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* 14. How much WATER you drink affects your skin as well.
How many glasses of water a day do you drink, aim for your best estimate if you are not measuring daily.

Over 3L a day (12 glasses+)

About 2L a day (8 glasses+)

About 1L a day (4 glasses+)

I really don't drink much water

Other (please specify)

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* 15. Sleep is a big component of our skin and how healthy it is.
Which best describes you?

I get a full nights rest (8 to 10 hours)

I sleep 6-8 hours and feel rested

I sleep less than 6 hours and feel rested

I sleep less than 6 hours and DON'T feel rested

I sleep many hours, but never feel rested

Other (please specify)

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* 16. If you have problem areas on your face, please upload a picture in good lighting without any makeup on, and switch off all filters.
Please make this a FACE shot only, from hairline to chin. Can show multiple angles if needed.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 17. Where did you come across this questionnaire?

Instagram

Faceboook

Google

On a Website

Personally sent link by consultant

Other (please specify)

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* 18. I'd love to have a chat with you about your answers above and help come up with the best skincare plan/solution for you.
When is it a good time to chat?

Morning (9am to 11:30am)

Afternoon (12pm to 3pm)

Evening (3:30pm to 7pm)

Night (7:30pm to 10pm)

Skin Care/Routine Questionnaire

Your skin is the largest organ of the body and absorbs everything!

Question Title

* 1. Please share your information below which helps with giving you pricing.

Question Title

* 2. Who sent you this questionnaire to complete? (Please share your consultant's full name)

Question Title

* 3. What is your current age (this helps us determine your skin needs)

Question Title

* 4. Please indicate which is accurate for you

Question Title

* 5. Have you ever used any Arbonne products before?

Question Title

* 6. If you had a MAGIC WAND and could change anything about your skin, what would you like to see different?What would your IDEAL skin look like?

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* 7. What concerns you most about your skin?Feel free to elaborate.

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* 8. Do you currently take any kind of vitamins to help your health regarding skin, (example collagen)? If so, Please elaborate which ones?

Question Title

* 9. What type of products are you currently using for your skin? (Ex. Cleanser, Toner, Mask, Moisturizer etc)

Question Title

* 10. What brands do you currently use for your skin care?

Question Title

* 11. Have you ever purchased skincare products from shops like Sephora, The Bay, Holt Renfrew, Saks 5th Avenue? If so, which store and what products?

Question Title

* 12. How would you best describe your skin type?

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* 13. Your skin is directly connected to your gut. What you EAT plays a huge role in the HEALTH of your skin, along with environment, hygiene and hormones.What best describes your daily routine?

Question Title

* 14. How much WATER you drink affects your skin as well.How many glasses of water a day do you drink, aim for your best estimate if you are not measuring daily.

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* 15. Sleep is a big component of our skin and how healthy it is.Which best describes you?

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* 16. If you have problem areas on your face, please upload a picture in good lighting without any makeup on, and switch off all filters.Please make this a FACE shot only, from hairline to chin. Can show multiple angles if needed.

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* 17. Where did you come across this questionnaire?

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* 18. I'd love to have a chat with you about your answers above and help come up with the best skincare plan/solution for you.When is it a good time to chat?

* 6. If you had a MAGIC WAND and could change anything about your skin, what would you like to see different?
What would your IDEAL skin look like?

* 7. What concerns you most about your skin?
Feel free to elaborate.

* 13. Your skin is directly connected to your gut. What you EAT plays a huge role in the HEALTH of your skin, along with environment, hygiene and hormones.

What best describes your daily routine?

* 14. How much WATER you drink affects your skin as well.
How many glasses of water a day do you drink, aim for your best estimate if you are not measuring daily.

* 15. Sleep is a big component of our skin and how healthy it is.
Which best describes you?

* 16. If you have problem areas on your face, please upload a picture in good lighting without any makeup on, and switch off all filters.
Please make this a FACE shot only, from hairline to chin. Can show multiple angles if needed.

* 18. I'd love to have a chat with you about your answers above and help come up with the best skincare plan/solution for you.
When is it a good time to chat?