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Questions marked with a * are required Exit Survey
 
Contact Information
* First Name : 
* Last Name : 
* Phone : 
* Email Address : 
 
 
 
* Age
   
 
 
 
* Any present illnesses
   
 
 
 
* Do you suffer from any of the following (Select all that apply)?
 
Dry Skin
 
Oily Skin
 
Shiny Skin with large pores
 
Acne
 
Psoriasis
 
Rash

 
 
 
*

Which of the following skin care products do you use at least once a week? 


(Select all that apply)?
 
Body lotion or moisturizer
 
Body powder
 
Antiperspirant
 
Sunscreen
 
Perfume or cologne
 
Other (please specify)

 
 
 
* Are you currently using any medication?
   
 
 
 
* Have you ever used XYZ Oil?
   
 
 
 
* What is the frequency of use?
   
 
 
 
* When was the last time you got your blood checked?
   
 
 
 
*

When choosing makeup products, which of the following factors matter to you (Select all that apply)?


 
Brand
 
Salesperson's recommendation
 
Friend's recommendation
 
Availability
 
Quality
 
Convenience
 
No testing on animals
 
Product ingredients
 
Price
 
Packaging
 
Other