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Skin Analysis Questionaire Normal Skin / Dry Skin / Combination Skin / Oily Skin. Which of these do you have? Find out by filling in this questionaire. I will email you the results. Contact: aloette@qualityinlife.com Please fill in the blanks. Fields marked with * are Required. Name: * Email Address: * Age: * Pick One 15 to 25 26 to 35 36 to 45 46 to 55 56 to 65 66 plus   Surface: * Pick One Dry Smooth Oily in "T zone" (Forehead / Nose / Chin) Shiny appearance over most of face   Pores: * Nearly invisible   Visible in some areas   Very obvious   Not Sure     Blackheads: * Pick One Few or none A few in "T zone" Several to many   Blemishes Appear: * Never or seldom   Occasionally or in monthly cycles   Frequently     Facial Lines (not expression lines): * Pick One Several on most areas of face and neck Few Forehead lines more around eyes and mouth Few if any concentrated around eyes and mouth   Shine Appears: * Very Seldom   Midday in the "T zone"   Within an hour     My Skin is: * Very Sensitive   A Little Bit Sensitive   Normal     I live in: * United States   Canada   Other     Comments: * Email Address - confirm: *

   

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