Back to Home Page
S k i n   C a r e   Q u e s t i o n n a i r e
ONE SAMPLE REQUEST PER PERSON
1
 Are you currently on a facial skin care regimen?  YES  NO
2
 What facial products do you use? 
3
 Which skin type are you:

Normal: Not too oily or dry, few blemishes, skin is firm and generally smooth with small pores.

Normal to Dry: Normal – Not too oily or dry, few blemishes, skin is firm and generally smooth with small pores. Dry – Due to sun and age, skin may lack natural oils. May look smooth with fine pores, few blackheads and belemishes. May show rough, flaky patches of dryness.

Normal to Oily: Normal - Not too oily or dry, few blemishes, skin is firm and generally smooth with small pores. Oily – Shiny and course, may have recurring blackheads and enlarged pores, often youthful-looking.

Combination: Oily T-zone (forehead, nose and chin). Normal to dry around cheeks and throat. Can be oily along chin, jaw, templates and dry elsewhere. May show rough flaky patches of dryness.

Blemishes: Generally oily. Blackheads and pimples. Potential scarring and pitting.

Sensitive: Extremely delicate. Broken capillaries, veins and vessels beneath skin surface. Should not be over stimulated.

Mature: Fine lines. Loose, "crepe-like" appearance. Loss of elasticity. Complexion may look "tired" and lackluster. 
4
 I have the following skin care goals/concerns: 
5
 Are you currently reading labels on products and making sure what you use is not only effective but also safe?  YES  NO 
6
 If you were given a FREE skin care sample, would you use it exclusively for a 3 day period and give us your opinion?  YES  NO 
7
 Areas of Interest (check all that apply):

Basic Skin Care Needs for Face
Anti Aging for Face
Detox
Men's Skin Care for Face
Sun Protection
Acne Treatment
Baby Care
Hormone Balancing Cream
Makeup
Weight Loss
Vitamins
Products for Teens
Aromatherapy
Spa Products
Cellulite Treatment
Holiday Gifts
Earning extra money every month
Building a home based business and driving a white Mercedes-Benz
8
 We are always pleased to receive feedback on our products and service new clients. We are also looking for people who may be interested in the following: freedom and flexibility, spending time with family, helping other people, being debt-free, retirement savings, owning your dream home, vacation and travel, more money, more time.

If any of the above applies to you, would you be open to taking a look at some information about having a home based business that you could work part time or full time and make an extra $300, $1500, $5,000 or higher a month?  Yes  No  Maybe
9
 If you try a sample and fall in love with it, would you be interested in receiving a discount on your products?  Yes  No
Name
Address
City
State
Zip
Country
Would you like to sign up for my E-Newsletter? …which includes tips and information on anti aging, skin care, health and beauty. It also includes information on new Arbonne products, specials and discounts throughout the year. Unsubscribe anytime.
Telephone (A valid contact number is required)
E-Mail Address (please enter carefully)
Questions? Comments?
Security Code:  PLEASE CLICK THE SUBMIT BUTTON
ONLY ONCE.
The information you submit here
will not be disclosed to third parties. 
For more information call
Sandra Tillinghast
Independent National Vice President
(888) 895-4383 toll free