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Create a Customized Skin Care Product
Required Required Question(s)
Required 1.
What is your email address?
 

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2.
Are you Male or Female?
Female
Male
3.
How old are you?
 

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4.
Which skin issues do you battle with?
 Big Problem Moderate Problem Mild Problem Not a Problem at all  
Acne  
Dry Skin  
Oily Skin  
Eczema or psoriasis  
Chapped or Cracked Skin  
Stretch Marks or Scars  
Wrinkles or Slack Tissue  
Bruises  
Cuts  
Other - Please Explain  
  • Comment:

  • 150 character(s) left.
5.
Is this for your face or body and hands?
Face
Body and hands
6.
Which types scent appeal to you?
 Love Like Neutral Dislike  
Floral  
Sweet and Heady  
Wood  
Herb  
Citrus  
Mint  
Spice  
7.
List any scents that you particularly enjoy.

Examples:
Allspice Anise Balsam- Peru Basil Benzoin Bergamot Carrot seed Cedarwood Chamomile- German Chamomile-Roman Cinnamon Clove Bud Cypress
Elemi Eucalyptus Fennel Frankincense Geranium Ginger Grapefruit Hyssop Jasmine Juniper Berry Lavender Lavindin Grosso Lemon Lemongrass Lime Litsea (May Chang) Mandarin Moroccan Chamomile Myrrh Myrtle Neroli Nutmeg Oakmoss Orange- Blood Orange- Sweet Oregano Palma Rosa Patchouli Pepper- Black Peppermint Pettigrain
Pine Needle Rose Absolute Rosemary Rosewood Sage-Clary Sage-Garden Sandalwood Spearmint Tangerine Teatree Thyme Vetiver Ylang Ylang
 

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8.
List any scents which you either dislike or are allergic to.
 

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9.
Check any of the below conditions you have.
Pregnant or Nursing
High Blood Pressure
Low Blood Pressure
Epilepsy
Sensitive skin
Do you have or are you recovering from a serious illness - Please Explain
Other -please explain
  • Comment:

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10.
Are you allergic to nuts and/or nut oils?
Yes
No
Other 
  • Comment:

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11.
Which methods of Aromatherapy do you enjoy?
Massage Oils
Skin Butters
Skin Mists
Balth Salts
Skin Lotions
Pure Essential Oil blends to add to your own unscented products and baths
Other
  • Comment:

  • 150 character(s) left.