Skincare Questionnaire Enter your text here NameEmail1) What's your birthday? Month, day, and year please.2) Where do you live? Please name the location and even give a brief description of your area (on the beach, the city, the desert, high elevation, etc)3) Check your TOP FIVE skin care concerns. In the box below, rank your concerns by listing the corresponding letter, 1 being your biggest concern, 5 being mild concerns. For Example: 1- K, 2- J, 3- C, 4- O, 5- G A) Acne B) Large Pores C) Uneven Texture D) Scarring E) Shiny/Greasy F) Stopping Premature Aging G) Dull Complexion H) Dry/Flaky I) Sagging Skin J) Repairing Fine Lines and Wrinkles K)Hyper Pigmentation/Dark Spots L) Sensitivity/Redness M) Eczema N) Puffiness O) Under Eye CirclesComments4) Use a clean, damp washcloth to cleanse your face, gently pat dry and wait 10 minutes. Describe your skin. (Choose up to three answers.) Looks Red Feels Tight Is Flaky Looks Shiny Is Greasy Feels Hot Feels Comfortable5) Three months after you're injured, your scars are Pink Brown6) Does sun exposure make you freckle? Yes No7) Describe your current skincare routine. Check all the products you use on a regular basis, and use the blank field below to describe any other products you like and how often you use your products. If you are low maintenance and don't use any product, you can put that in the blank field too! Makeup Remover Gel Cleanser Cream/Oil Cleanser Toner Serum Mask Moisturizer Eye Cream Exfoliant Body Lotion Body ScrubComments8) What allergies do you have? (Nuts, ragweed, bees, etc)