*Required 
1) Which skin type do you have? *
Dry
Sensitive
Normal
Combination
Oily, Problematic
Do not know

2) Do you receive facials from a licensed professional regularly? *
Yes
No


3) What skin care products have you used in the past?
 
3a) Have they improved the health of you skin?  
Yes
No


  
4) What are your greatest concerns regarding your skin?


  
5) What allergies, if any, do you currently have? *   



 
6) What type of climate exists where you currently reside?


  
7) How much sun are you exposed to on a daily basis?


  
7a) Do you utilize sun protection daily? *  
Yes
No
8) Do you participate in any activities that may affect your skin? (swimming, skiing, etc).


  
9) What is your daily water intake in ounces? *


 
10) Would you like Outersoul Aesthetics to suggest a specific skin care line based upon your analysis? *   
Yes
No

  
Name *
Address
  
City
  
State
  
Zip
  
E-mail Address: *