SKIN CARE PRODUCTS BY NATURALLY YOURS
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There are many factors to consider before choosing the right skin care products. Factor's such as your age, environment and skin type are key in determining what products are best suited for you. The following questionnaire will help us guide you in the care of you skin.
Please provide the following contact information:
*Your Name:
*Your Email:
*Your Phone:
*Your Age:
*1. Start by selecting your natural skin tone:
Fair
Medium
Dark
*2. What best describes your natural eye color?
Blue to Green
Hazel
Brown to Dark Brown
*3. How dry is your skin?
Not Dry
Moderately Dry
Dry All Over
*4. How oily is your skin?
Not Oily
Oily in the T-Zone (forehead, nose, chin)
Oily All Over
*5. Do you have blemishes?
No Blemishes
A Few Blemishes
Blemishes All Over
*6. Does your skin become red, blotchy or dry because of environmental conditions (i.e. heat, cold, wind, air-conditioning)?
No
Sometimes
Always
*7. How sensitive is your skin?
Not Sensitive
Moderately Sensitive
Sensitive All Over
*8. Please specify if you are allergic or have sensitivities to any product or specific ingredient?
*9. Do you have lines and/or wrinkles?
No Wrinkles
A Few Wrinkles
Wrinkles All Over
*10. How does your skin respond to sun exposure?
Burns Easily
Changes From Burn To Tan
Tans Easily
*11. Does your skin have any dark spots?
No Dark Spots
A Few Dark Spots
Many Dark Spots
*12. Which product line are you interested in using?
*13. Which product lines have you tried in the past?
*14. How would you like to be contacted:
E-Mail
Phone
*15. Please describe your main skin care concerns or questions:

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June 28, 2007
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Naturally Yours Skin Care Store® Copyrights 1999-2008
 120 - 100 East 1 Street, North Vancouver, BC V7L1B1