Let us know how you feel about your eye wrinkles.


Please take a few moments to complete the questions below. Your responses will be held strictly confidential. Most important, however, they will provide us with information to help you look younger than you actually are.

* 1. How old are you?

* 2. Are you male or female?

* 3. What problems do you currently experience with the area around your eyes? Select all that apply.

* 4. How do you feel your eye wrinkles make you look? Select all that apply.

* 5. What, if anything, have you done to address wrinkles around your eyes? Select all that apply.

* 6. What methods have you used, that worked, to get rid of your eye wrinkles? Specifically identify the name of eye creams, procedures, etc.

* 7. Which topics would you like to learn more about as they relate to eye wrinkles? Select all that apply.

* 8. How many kids do you have?

* 9. Are you married?

* 10. In what city and country do you live?