Skin Hydration Survey Question Title * 1. What is your Name and Surname? Question Title * 2. Which Skin Renewal branch is your Home Branch? Bedfordview Brooklyn Cape Quarter Claremont Constantia Durban Fourways Illovo Irene Morningside Paarl Parkhurst Stellenbosch Umhlanga West Rand Willowbridge Question Title * 3. If you would like us to update your e-mail address on our client database, please fill in your current email address below? Question Title * 4. Please specify your age? Between ages 20 and 30 Between ages 31 and 40 Between ages 41 and 50 Between ages 51 and 60 61+ Question Title * 5. Which of the below concerns you most about your skin? Fine lines Wrinkles Puffiness Mild sagging Dehydration Age spots Enlarged pores Blocked pores Congestion Breakouts General anti-ageing Question Title * 6. Which area of your face is the most bothersome, and showing signs of ageing? Eye area (dark circles, fine lines, and thinning skin) Hollow cheeks and temples Deep mouth frown lines Decreased volume in lips Excessive frown lines Excessive facial wrinkles Sun damage and pigmentation Question Title * 7. Do you live a healthy lifestyle? Select which of the below apply to you? Eat a well balanced diet, consisting of raw food and mininal / no processed food Drink enough water Get enough sleep Exercise regularly Reduce stress levels Moderate intake of alcohol Quit smoking / do not smoke Question Title * 8. The skin needs regular in-salon treatments for effective anti-ageing benefits. Products alone are not enough. Have you had any anti-ageing skin treatments done? Yes No Question Title * 9. What facial anti-aging treatments, aside from injectables, have you had? Laser treatments (Laser Genesis, Fraxel Dual, Titan, Limelight) Skin Needling Chemical peels Radiofrequency Carboxytherapy Photo Dynamic Therapy Other (please specify) Hydra Touch Facial Other (please specify) Question Title * 10. The Renewal Institute now offers The Hydra Touch Facial .What does this treatment include? Hydradermabrasion (deep cleansing and cleaning the skin) Peel infusion (with either an AHA or a BHA) Transdermal Mesotherapy with a hydrating serum Skin tightening Hydrating Mask Question Title * 11. Following a skin care regime, customised to your skin's needs, is vital to give your skin daily nourishment, corrective and protective benefits. Do you have prescribed skin care and a daily routine? Yes No Question Title * 12. To help prevent premature ageing the most important factor is to stay out of the sun! To protect your skin it is vital that you apply a broad spectrum SPF each and every day. Do you use daily SPF? Yes No Sometimes Question Title * 13. Would you like a Renewal Institute staff member to contact you to discuss the survey? Yes No Question Title * 14. Has your disposable income been a hindrance to you being able to do facial anti-aeging treatments? Yes No Question Title * 15. Please take a few moments to give a Facebook review of your experience with your treatments, therapist or branch by clicking on the relevant branch link below: Bedfordview Brooklyn Cape Quarter Claremont Constantia Durban Fourways Illovo Irene Morningside Parkhurst Paarl Stellenbosch Umhlanga West Rand Willowbridge Done
