Survey Questions

Choose the answers that best fit you.

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* 1. First & Last Name

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* 2. What country do you live in?

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* 3. What is your skin type?

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* 4. When it comes to your eyes, what is your biggest concern?

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* 5. What is your primary concern for your skin?

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* 6. Any secondary concerns?

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* 7. Please list and additional questions or information here.

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* 8. How can I contact you with your results? (Phone number, email, Instagram tag)

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