Skincare Questionnaire - Zen Body & Skin

Name *

First

Last

Email *

Phone Number

How did you hear about Zen Body & Skin?

Your Age

Type of Skin (Check all that apply)

Skin Concerns (Check all that apply)

Other Skin Concerns

If you have any allergies or sensitivities to ingredients/scents list them here

Do you use a prescription from a dermatologist? If yes, please explain.

Do you smoke?

Do you drink alcohol?

How well do you sleep?

How would you describe your current health?

Describe your stress level

How is your diet?

Current Skincare

Describe your current skincare routine

What do you feel might be missing from your skincare routine?

What are things you like or dislike about your current skincare?

What are important features you look for in skincare? (Check all that apply)

Please list anything else that is important to you when shopping for skincare

Have you ever had a facial before?

If you've had a facial before, describe what you liked or disliked about the experience

When receiving a facial, what are your expectations?

List any other goals/expecations you have during a facial?

In the last 60 days have you had any of the following procedures?

Do you have any of the following?

Is there anything else you would like me to know about your skin or health?