1. In your opinion, is your skin predominantly oily or dry?*

2. Does your skin feel tight after cleansing?*

3. The porosity of the skin, fine pores, large pores?*

4. Your age is?*

5. Does your skin have wrinkles? None, a few, or some?*

6. Inflammations? Often, never?*

7. Cellulite? Yes - No*

8. Red veins? Yes - No*

9. Is your skin sensitive? Very sensitive or not sensitive at all*

10. Known allergies?*

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First name*

Last name*

E-mail address*

Telephone number*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

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