1. Your skin type:

Dry

Normal

Combination

Sensitive

2. Your age:

Under 25

25 to 39

40 to 50

Over 51

3. To cleanse and remove make up, do you prefer:

a water-rinse cleanser

a milk and a lotion

a one-step cleanser

4. What are your beauty goals?

Priority goals

Secondary goals

Reduce the appearance of wrinkles

Reduce feelings of dryness or tightness

Lift and firm the complexion

Reduce redness and sensitivity

Reduce small spots

Reduce the appearance of tiredness

Protect from Environmental damage

5. Your specific concerns for the under eye area:

Reduce the appearance of fine lines or crows feet

Reduce dark circles or undereye puffiness

6. Do you smoke:

Never

Occaisonally (less than ten cigarettes a week)

Regularly (more than ten cigarettes a week)

Heavily (more than 10 cigarettes a day)