Health & Beauty Products - April 2019
Free Product Testing Opportunity: Health & Beauty Products
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1.
First Name
(Required.)
*
2.
Last Name
(Required.)
*
3.
Email Address
(Required.)
*
4.
Phone number
(Required.)
*
5.
Country
(Required.)
USA
Canada
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6.
Do you suffer from any of the following scalp conditions?
(Required.)
Itchy, flaky or dry Scalp
Psoriasis
Seborrheic Dermatitis
Scalp Eczema
Dandruff
Other (please specify)
*
7.
Do you use any of the following products to treat your scalp?
(Required.)
Dandruff Shampoo
Tea Tree Oil
Coconut Oil
Aloe Vera
Apple Cider Vinegar
Not Applicable - I do not use any products for my scalp
Other (please specify)
*
8.
Do you suffer from any of the following fungal skin conditions?
(Required.)
Athletes Foot
Ringworm
Jock Itch
Rashes
Not Applicable
Other (please specify)
*
9.
Do you suffer from any of the following skin conditions?
(Required.)
Itchy skin burning
Burning skin sensation
Scaling skin
Red, cracked and sore skin
Chafing, irritated skin
Eczema
Rosacea
Acne
Psoriasis
Not Applicable - I do not suffer from any of these symptoms
Other (please specify)
10.
What kind of products do you use to treat your skin conditions?
Topical oral medication
Topical creams
Antihistamines
Medicated creams and ointments
Over the counter creams and ointments
Other (please specify)
*
11.
Would you be interested in testing health & beauty products?
(Required.)
Yes
No
