Surveypoint

Q1

Date and Time of your Session

Month

Q2

Date and Time of your Session

Day

Q3

Date and Time of your Session

Year

Q4

Date and Time of your Session

Hour

1

2

3

4

5

6

7

8

9

10

11

12

Q5

Date and Time of your Session

Minutes

00

15

30

45

Q6

Date and Time of your Session

AM/PM Option

AM

PM

Q7

Beauty Session:

In-person

Virtual

Q8

Name*

First Name

Q9

Name*

Last Name

Q10

Phone Number*

Area Code

Q11

Phone Number*

Phone Number

Q12

Full Mailing Address*

Street Address

Q13

Full Mailing Address*

Q14

Full Mailing Address*

City

Q15

Full Mailing Address*

State

Q16

Full Mailing Address*

Zip Code

Q17

Email*

Q18

Who referred/invited you:*

Q19

When was the last time that you bought or sampled Mary Kay:

Q20

What Type Skin Do You Have?*

Dry

Normal

Combination

Oily

Q21

Your Primary Skin Needs:*

Simple Cleaning Routine

Prevent Signs of Aging

Repair Signs of Aging

Moderate Acne

Prefer Natural Skincare

Sensitive Skin like rashes and allergies

Q22

Areas of concern/needs:*

Improve Uneven Skintone & Texture

Improve Skin Firmness

Increase Hydration for Dry Skin

Reduce & Clean Pores

Minimize Wrinkles

Reduce Puffy & Dark Under Eye Area

Dry, Chapped Lips

Q23

Skin Tone (today):*

Very Ivory

Medium Ivory

Beige

Olive

Bronze

Deep Bronze

Q24

Birthday:*

Q25

Eye Color:*

Q26

Beauty Session Profile -Form Fill

Date and Time of your Session

Date and Time of your Session

Date and Time of your Session

Date and Time of your Session

Date and Time of your Session

Date and Time of your Session

Beauty Session:

Name*

Name*

Phone Number*

Phone Number*

Full Mailing Address*

Full Mailing Address*

Full Mailing Address*

Full Mailing Address*

Full Mailing Address*

Email*

Who referred/invited you:*

When was the last time that you bought or sampled Mary Kay:

What Type Skin Do You Have?*

Your Primary Skin Needs:*

Areas of concern/needs:*

Skin Tone (today):*

Birthday:*

Eye Color:*

Tell me a little about yourself (hobbies, etc):