One Minute Skin Spa Quiz
One Minute Skin Spa Quiz
Name:_____________________________ Phone_____________________
Email: _________________________________Best time to call__________
[Your personalized skin care results will be sent via e-mail]
Birthday: _______________Cleanser:______Tonic______Moisturizer_____
Select the descriptions that best describe the SKIN AROUND YOUR EYES:
Please answer ALL
Not at All
Barely
Moderately
More
questions!
Visible
Visible
Pronounced
Fine Lines
Dark Circles
Puffiness
Loss of Firmness
& Elasticity
Dryness
Select the descriptions that best describe your SKIN’S OVERALL appearance:
Fine Lines
Deep Wrinkles
Age Spots & Sun
Damage
Loss of Firmness
& Elasticity
Large Pores
Dull Skin/Lack of
Clarity
Select the descriptions that best describe you SKIN’S SENSITIVITY: (circle one)
Little to None Mildly Sensitive Moderately Sensitive Very Sensitive
How often do you experience breakouts? (Circle one)
Rarely, if at all
Monthly
Weekly
Daily
Ethnicity: Asian African American Hispanic/Latino Native American
Caucasian Other
Age: Under 20
20-29 30-39
40-49
50+
Would You Like To:
Host a Spa or makeup party in your home?
One-on-One Consultation?
Yes
No
Maybe


Saving money on products for myself & family
Making extra money each month? 

Name:_____________________________ Phone_____________________
Email: _________________________________Best time to call__________
[Your personalized skin care results will be sent via e-mail]
Birthday: ________________Cleanser:______Tonic______Moisturizer_____
Select the descriptions that best describe the SKIN AROUND YOUR EYES:
Please answer ALL
Not at All
Barely
Moderately
More
questions!
Visible
Visible
Pronounced
Fine Lines
Dark Circles
Puffiness
Loss of Firmness
& Elasticity
Dryness
Select the descriptions that best describe your SKIN’S OVERALL appearance:
Fine Lines
Deep Wrinkles
Age Spots & Sun
Damage
Loss of Firmness
& Elasticity
Large Pores
Dull Skin/Lack of
Clarity
Select the descriptions that best describe you SKIN’S SENSITIVITY: (circle one)
Little to No Mildly Sensitive Moderately Sensitive Very Sensitive
How often do you experience breakouts? (Circle one)
Rarely, if at all
Monthly
Weekly
Daily
Ethnicity: Asian African American Hispanic/Latino Native American
Caucasian Other
Age: Under 20
20-29 30-39
Would You Like To:
Host a Spa or makeup party in your home?
One-on-One Consultation?
40-49
50+
Yes
No
Maybe


Saving money on products for myself & family
Making extra money each month? 
