AktaDerm Customer Survey

1. How often do you use skin care products?

How often do you use skin care products? Never

Few times in one year

Few times in one month

1 to 2 times in a week

3 to 4 times in a week

5 to 6 time in a week

Once a day

More than once a day

2. On average, how often do you purchase skin care products?
Choose only one of the following

On average, how often do you purchase skin care products? Choose only one of the following More than once in a week

Once a week

Once every 2 to 3 weeks

Once a month

Once every 2 to 4 months

Once every 5 to 12 months

Never

3. On average how much do you spend on skincare products each month?

On average how much do you spend on skincare products each month? less than $10

$10-$20

$20-$40

$40-$80

$80-$160

more than $160

4. Where do you most often buy skin care products?

Where do you most often buy skin care products? Grocery Store

Drug Store/Pharmacy

Department Store

Beauty Salon/Spa

Cosmetic Store

Online

Other

5. Where do you obtain advice or learn about new products?

Where do you obtain advice or learn about new products? Television

Internet

Magazine/Newspaper

Friends/Family

Beauty Salon

6. I read the list of ingredients on the label before purchasing.

I read the list of ingredients on the label before purchasing. Always

Most of the time

Rarely

Never

7. What skin conditions do you want to treat and how severe are they?

	Not a Problem	Mild problem	Big Problem
Dry skin	*What skin conditions do you want to treat and how severe are they? Dry skin Not a Problem	Dry skin Mild problem	Dry skin Big Problem
Oily skin	Oily skin Not a Problem	Oily skin Mild problem	Oily skin Big Problem
Acne / Blemishes	Acne / Blemishes Not a Problem	Acne / Blemishes Mild problem	Acne / Blemishes Big Problem
Wrinkles	Wrinkles Not a Problem	Wrinkles Mild problem	Wrinkles Big Problem
Sagging skin	Sagging skin Not a Problem	Sagging skin Mild problem	Sagging skin Big Problem
Dark spots / uneven skin tone	Dark spots / uneven skin tone Not a Problem	Dark spots / uneven skin tone Mild problem	Dark spots / uneven skin tone Big Problem
Dark circles around eyes	Dark circles around eyes Not a Problem	Dark circles around eyes Mild problem	Dark circles around eyes Big Problem

What other skin problems do you want to solve?

8. For free sample, please fill out information below.

For free sample, please fill out information below. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Phone Number:

9. Would you like to receive notifications about other special offers by email? These can include free samples of our other products or one-day sales events. By clicking "yes" you also agree to AktaDerm's terms and conditions found at www.aktaderm.com.

Would you like to receive notifications about other special offers by email? These can include free samples of our other products or one-day sales events. By clicking "yes" you also agree to AktaDerm's terms and conditions found at www.aktaderm.com. Yes

No