Home
Shop Beautycounter
Join my Better Beauty VIP Group
Blog
Links

Hi! Fill out my skincare survey to get free samples!

I’d love to make some personalized recommendations for you. Tell me about your skin below, and be sure to include your address if you want me to mail you some free samples!

Skincare Survey

First

Middle

Last

Phone

Address (fill out if you want samples mailed to you)

Street Address

Address Line 2

City

State / Province

ZIP / Postal Code

Have you heard of Beautycounter before?

Yes

Have you purchased Beautycounter products before?

Yes

How old are you?

Under 18

18 – 24

25 – 29

30 – 34

35 – 45

45+

What would you consider to be your skin type?

Normal (no or few blemishes, balanced, etc.)

Oily (dull or shiny complexion, blackheads and breakouts more common, large pores common)

Dry (dull or rough complexion, irritation common, flaky)

Combination (areas of both dry and oily skin usually along the forehead, nose, and chin)

Sensitive (does not tolerate many products well , redness, irritation, itchy, burning common)

What’s your primary skin concern?

active acne / too much oil

dryness

aging skin

no major concerns – just want safer products

What are your secondary skin concerns?

dullness

large pores

redness

skin spots/discoloration

fine lines/wrinkles

acne scars

eczema

dark spots

other

If you have had a reaction to skin care products before, please tell me more about what products and what happened.

What does your current skincare routine consist of? (Please list the brand/company and what you like/dislike)

Do you have a budget in mind? If so, what range would you like to stay in to get started?

Less than $50

$50-$100

$100-$150

$200 or more

I’m open–depending on what’s needed

8. Are you interested in hearing about our makeup line and recommendations on product?

Yes

No, not at this time

If interested in cosmetics, please tell me a little bit about which products you currently use and would be interested in replacing with safer options.

Please list any other concerns or questions you might have here. Happy to help!

hello@justbetterwithbethany.com

This site was created by Bethany McCoy, Brand Advocate with Beautycounter. Beautycounter has no connection with this site and does not sponsor or support its content.