Skincare Questionnaire Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which of the following statements applies to you best?
*
I have oily skin
I have acne
I have dry and dull skin
I have an uneven skin tone
I have wrinkles
I have pigmentation
I suffer from redness and sensitivity
I have a combination skin
I have brown spots from sun damages
Other
How important having a healthy skin to you?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Which skincare products do you currently use?
*
Makeup remover
Anti-aging cream
Skin Toner
Body cream
Cleansing milk
Eye products
Cleanser
Night treatment
Moisturizer
Other
How important for you to use samples before buying skincare products?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Where do you get information about skincare products?
*
In shops
Bloggers
Magazines
Television
Word of mouth
Internet
Influencers
Other
How often do you buy skincare products?
*
Rarely
1
2
3
4
Very often
5
1 is Rarely, 5 is Very often
Where do you purchase your skin care products?
*
Online
Catalogues
In store
Department stores
Pharmacy
Beauty shops
Other
Please indicate how much do you spend on skincare products on a monthly basis on average.
Please tell us which product/service you want to get more information about?
Submit
Should be Empty: