TeriLyn Adams Skincare Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hi! I'd love to help you get on a skincare routine that works! Fill out the information below and I'll get back to you with recommendations ASAP!

In the meantime, sign up for my skincare newsletter HERE: https://a-foodie-stays-fit.ck.page

You'll get more information about how to take care of your skin and if you've never purchased Beautycounter, you'll get a 20% off promo code.

Thanks!
TeriLyn

terilynadams.com

Email *

1. Your name: *

Do you have a consultant you already shop with? *

Yes, I plan to order with her/him

No, I plan to order with you

Did you drop your email address for my skincare emails? If not, click the following link to sign up: https://a-foodie-stays-fit.ck.page *

Yes, just did it!

Phone Number (so I can text you about promos!)

Have you purchased Beautycounter products before? *

Yes

2. How old are you?

Under 18

18-24

25-29

30-34

35-45

46+

Clear selection

3. 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)

4a. What's your primary skin concern? *

active acne / too much oil

dryness

aging skin

no major concerns - just want safer products

Other:

4b. What are your secondary skin concerns? *

dullness

large pores

redness

skin spots/discoloration

fine lines/wrinkles

acne scars

eczema

Other:

Required

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

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

7. 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

9. 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. *

10. Are you interested in becoming a consultant? (There are some FAQs here: https://www.afoodiestaysfit.com/beautycounter-consultant-faq/) *

Yes, I want to learn more!

No, not right now

Maybe! Gotta think about it.

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

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms