Interactive Skin Care Analysis

Welcome to the TotalSkinCare.com interactive skin care analysis.

The purpose of this exercise is to ask you to think about the type of skin you have and how you are currently caring for it, and second, to give us an opportunity to offer you some feedback!

Whether you are just looking for guidance on general skin care or have some specific concerns about your skin, we would be pleased to share our thoughts and suggestions with you.

In the future, TotalSkinCare.com will provide in-depth discussions about general skin care, as well as specific skin ailments and suggested treatment. As always, you are welcome to contact us by email to discuss your personal skin care in greater detail.

* Denotes required field

Personal Information
 
Name:
Address:
City:
State:    *Zip:
Country:
*Email:
May we add you to our Mail List? Yes     No
Daytime Phone:
 
How did you hear about us?
Google www.bjcohen.com
Yahoo www.lyb.com
Msn.com Friend or family
Froogle Other Search Engine
     (please specify below)    
 
Skin Assessment Questionnaire
 
*I am: Male      Female
 
My Age Range is: 18-30 31-49 50+
 
*My Skin is:
 

Fair: I rarely tan and usually burn

Light: I may tan but I usually burn

Light/Medium: Sometimes I tan, sometimes I burn

Medium: I usually tan but I sometimes burn

Dark: I rarely burn
 
Would you be interested in receiving information about
dermal filler injections like collagen? Yes No
 
Do you currently take Oral Vitamin Supplements: Yes No
 
*I would describe my skin type as:
 
 

Sensitive

Dry

Normal

Combination

Oily
 
*I am interested in Products containing (check all that apply):
 
Glycolic Acid (exfoliator)
Salicylic Acid (acne prone skin)
Hydroquinone (skin bleacher and lightener)
Antioxidants (Vitamins A, C, and E)
Copper Peptides
It does not matter
 
*I am looking for the following product type (check all that apply):
 
Cleanser
Toners
Lightening/Bleaching Agent
Moisturizer
Eye Care
Lip Care
Complete Skin Care Regimen
It does not matter
 
*I have the following skin related concerns:
 
Preventive Maintenance (How to avoid premature aging)
Acne Problems:
    Teenage (acne prone skin) Adult Acne
Facial Wrinkles and Fine Lines
Dark Pigmentation Spots
Eyes: Fine Lines & Wrinkles Puffiness and Under Eye Bags
It does not matter
 
If Possible Please Recommend Products From:
 
Cellex-C
M.D. Forte
Neo Strata
Neova + Procyte
Glyderm
Obagi
Gly-Med Plus + Physicians Elite
Physicians Choice
Jan Marini
Skinceuticals
Total Skin Care
Skin Medica
It does not matter