Skin Goals Questionnaire

Skin Goals Questionnaire

This will take you just 2 minutes to fill but will allow me to build a profile for you! I can make the best recommendations after learning a bit about your concerns and goals.
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!
Please answer the following so we can start your profile:*
What is the best email we can send your customized skin recommendations to?
[email protected]
Please answer the following, this helps us determine issues around hormones and such.*
Have you ever used Arbonne skincare products before?

NoYes (Please share which ones in particular)
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?
What concerns you most about your skin? Feel free to elaborate.

Active Acne and Acne ScarsDrynessFine Lines/WrinklesLoss of Firmness (loose skin)Puffiness or Dark Circles under EyesTight Feeling/Lack of HydrationUneven Tone or Pigmentation (including any spots, scars)Other (Please specify anything that my have been missed)
Do you currently take any kind of vitamins to help your health regarding skin, (example collagen etc)? If so, Please elaborate which ones?
What type of products are you currently using for your skin? (Ex. Cleanser, Toner, Mask, Moisturizer etc)
What brands do you currently use for your skin care?
Have you ever purchased skincare products from shops like Sephora, The Bay, Holt Renfrew, Saks 5th Avenue? If so, which store and what products?
How would you best describe your skin type?

NormalDryOilyCombination (Dry and Oily)Oily with AcneDry with AcneCombination with AcneSensitive Skin (I react to EVERYTHING!)Other (Please describe)
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 everydayI try to eat healthy, but my cravings get the best of me several times a weekOther (please specify)
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 waterOther
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 restedI sleep less than 6 hours and feel restedI sleep less than 6 hours and DON'T feel restedI sleep many hours, but never feel restedOther
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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Where did you come across this Questionnaire?

InstagramFacebookOn a WebsiteGooglePersonally Sent Link by SheelaOther (Please Specify)
When is a good time to get in touch with you? (check all that apply)

Morning (9am to 11:30am)Afternoon (12pm to 4:30pm)Evening (5pm to 8:30pm)Late Night (9pm to 11:30pm)
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