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Skincare Expert Guidance Questionnaire
I'm so glad you're here! Please take a few minutes to complete this questionnaire so I can get to know your skin and put together a routine that's truly personalized for you. If there's any question you'd rather not answer, feel free to skip it.
About You
Full name
*
Email
*
Phone
Age range
*
A
Under 20
B
20–29
C
30–39
D
40–49
E
50–59
F
60+
Skin Type
How would you describe your skin most days?
A
Oily
B
Dry
C
Combination (oily T-zone, dry cheeks)
D
Normal/balanced
E
Sensitive/reactive
F
Not sure
Does your skin react easily to new products (redness, stinging, breakouts)?
A
Yes
B
No
C
Sometimes
How sensitive would you say your skin is?
0
1
2
3
4
5
6
7
8
9
10
Skin Conditions & Concerns
Which of the following do you currently experience? Select all that apply.
Acne/breakouts
Blackheads/clogged pores
Hyperpigmentation/dark spots
Melasma
Rosacea/redness
Eczema/dermatitis
Fine lines/wrinkles
Loss of firmness/sagging
Dullness/uneven texture
Enlarged pores
Dark circles/under-eye puffiness
Scarring
Excess facial/body hair
Hair thinning or loss
None of the above
Please list any allergies or sensitivities to skincare ingredients
Goals
What are your top skincare goals right now? Select all that apply.
Clear up acne/breakouts
Even out skin tone
Reduce fine lines/wrinkles
Improve firmness/elasticity
Calm redness/sensitivity
Minimize pores
Boost hydration/glow
Fade dark spots or scarring
Address hair thinning
General maintenance/prevention
Lifestyle
How much direct sun exposure do you get on a typical day?
A
Minimal (mostly indoors)
B
Moderate (some outdoor time)
C
High (outdoor job or frequent sun)
Do you wear sunscreen daily?
A
Always
B
Sometimes
C
Rarely
D
Never
Do you exercise regularly?
A
Yes, most days
B
A few times a week
C
Rarely
D
No
What's your local climate like?
A
Humid
B
Dry
C
Cold winters/hot summers
D
Mild year-round
Are you currently pregnant, trying to conceive, or breastfeeding?
A
Yes
B
No
C
Prefer not to say
Current Routine
How would you describe your current routine?
A
Minimal (cleanser only)
B
Basic (cleanser + moisturizer)
C
Moderate (3–5 products)
D
Extensive (6+ steps)
What products do you currently use, morning and evening? (Or if you prefer to snap a photo, advance to next question:
Snap a photo of the products on your shelf:
Click to choose a file or drag here
Size limit: 10 MB
Which of these active ingredients are you currently using?
Retinol/retinoids
Vitamin C
AHA/BHA exfoliants
Niacinamide
Hydroquinone
Benzoyl peroxide
None of these
Not sure
Do you currently use a retinol (over-the-counter) or a prescription retinoid (e.g., tretinoin)?
A
Yes, an over-the-counter retinol
B
Yes, a prescription retinoid
C
No
D
Not sure
Have you experienced sensitivity or intolerance to retinoids?
A
Sensitivity — some redness, dryness, or peeling that improved with continued use
B
Intolerance — had to stop using it altogether
C
No, neither
D
Not sure
Are you using any prescription skincare or oral medication for your skin or hair?
A
Yes
B
No
Approximate monthly budget for skincare products
A
Under $50
B
$50–100
C
$100–200
D
$200+
E
N/A — whatever it takes
How much time are you willing to spend on your routine daily?
A
Under 5 min
B
5–10 min
C
10–20 min
D
20+ min
Anything Else
Are there any specific products or categories of products you'd like included in your shelf?
Anything else you'd like me to know before your consultation?
Who may I thank for referring you to me?
Submit