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Existing Client Skin Care Questionnaire

Please fill out the form below if you are an existing client and would like to enhance your results.  We will provide suggestions about complementary product technologies to take your skin to the next level!

Please provide the following information for the person this Skin Care Plan is for:

First Name:

Last Name:

Please Enter your email address so we can notify you when your Skin Care Plan is finished:

If you would like easy access to your customer information, including the ability to quickly reference past orders and/or Skin Care Plans you can assign a password to your account (optional):

Confirm Password:

1. How old are you?
2. Are you male or female?
Male
Female
3. What is your skin type?
Dry (facial skin is very dry)
Oily (Entire face is very oily)
Combination (t-zone tends to be oily)
Normal
4. Which Jan Marini products do you currently use? If you use products from another line, please tell us what else you use.
5. How long have you been using Jan Marini products?
6. What aspects of your facial skin would you like to improve? Check all that apply.
Enlarged pores
Overall hydration & luminosity
Acne
Rosacea
Clarity
Texture
Tone
Firmness
Fine lines & wrinkles
Uneven pigment
7. What other areas would you like to improve?
Eye area
Mouth area
Eyelashes
Hair
Lips
Body
None
8. Which of the following conditions would you like to address around your eye area?
Rough skin
Puffiness
Sagging skin
Dark circles
Fine lines and wrinkles
Scar reduction
None
Dry skin
9. Please list any other information that will help us make the best recommendations for you!
 
 
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