Questionnaire – Azar Organics

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Skin Analysis Questionnaire

This questionnaire will give us a better understanding of your skin and make it easier for us to formulate your products. It’ll take you about 5 minutes to complete. Afterwards, we’ll send you the results and our recommendations for your personalized skincare kit.

Name*
First Last
Email*
Gender*
- Male
- Female
How old are you?*
- 14 - 24 years old
- 25 - 35 years old
- 36 - 49 years old
- > 50 years old
What is your skin type?*
- Oily
- Dry
- Normal
- Combination
What are your skin goals? (choose all that apply)*
- Better, healthier skin
- Address my skin concerns such as acne, dark spots, hyperpigmentation
Please provide information on any skin problem you have
ABOUT YOUR SKINCARE REGIMEN
What products are you currently using in your skincare regime?*
- Cleanser
- Toner
- Moisturizer
- Eye Cream
- Face Oil
- Face Mask
- Exfoliator
- Serum
- SPF
- Others
Please tick all that apply
If there are others, please specify
Does your skin react with redness, itching, burning or dryness on application of skin care products?*
- Yes
- No
- Sometimes
Are you currently using any prescription skin lightening creams that contain Steroids/Tretinoin/Hydroquinone?*
- Yes
- No
- I don't know
How's your skin responding to your current regimen?*
- Very well
- Not so well
- I'm not seeing any changes yet
Are you receiving any of the following treatments?*
- Botox
- Micro Needling
- Microdermabrasion
- Facials
- Skin Peels
- Fillers
- None
- Others
Please tick all that apply
If there are others, please specify
Do you scrub your face with a sponge?*
- Yes
- No
- Sometimes
Do you air dry your face or use a towel?*
- I air dry my face
- I use a towel
If you use a towel, do you have a separate towel for your face?*
- Yes, I do
- No, I use the same towel for my face and body
ABOUT YOUR LIFESTYLE
Do you wear makeup on a regular basis?*
- Yes
- No
Do you have any known allergies?*
- Yes
- No
If yes, please specify
How would you describe you stress level?*
- Low
- Moderate
- High
- High, but under control
How would you describe your diet?*
- Good
- Average
- Poor
On average, how many glasses of water do you drink a day?*
- 1-5 glasses
- 6 - 10 glasses
- 10 - 14 glasses
- 15+ glasses
On average, how many hours sleep do you get each night?*
- 0-4 hours
- 4-8 hours
- 8-12 hours
- 12+ hours
Do you smoke?*
- Yes
- No
- Sometimes
- Hardly Ever
Do you pick at your face?*
- Yes
- No
- Sometimes
Do you put your phone on your ear when answering calls or use earphones?*
- Yes
- No
- Sometimes
Do you sleep with a satin/silk pillow case and/or bonnet?*
- Yes
- No
- Sometimes
Do you use any hair products?*
- Yes
- No
If yes, please specify
Are you allergic to any skincare ingredient?*
- Yes
- No
If yes, please specify
Upload a picture
To make an even more accurate assessment of your skin, you have the option of uploading three pictures of your face (Front view, Left side of your face and Right side of your face). Please make sure the pictures are clear with good lighting and only submit unaltered pictures without make-up.

Azar Organics

Azar Organic Cosmetics is a Nigerian based organic skincare brand.

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