Skin Hydration Survey
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1.
What is your Name and Surname?
(Required.)
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2.
Which Skin Renewal branch is your Home Branch?
(Required.)
Bedfordview
Brooklyn
Cape Quarter
Claremont
Constantia
Durban
Fourways
Illovo
Irene
Morningside
Paarl
Parkhurst
Stellenbosch
Umhlanga
West Rand
Willowbridge
3.
If you would like us to update your e-mail address on our client database, please fill in your current email address below?
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4.
Please specify your age?
(Required.)
Between ages 20 and 30
Between ages 31 and 40
Between ages 41 and 50
Between ages 51 and 60
61+
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5.
Which of the below concerns you most about your skin?
(Required.)
Fine lines
Wrinkles
Puffiness
Mild sagging
Dehydration
Age spots
Enlarged pores
Blocked pores
Congestion
Breakouts
General anti-ageing
6.
Which area of your face is the most bothersome, and showing signs of ageing?
Eye area (dark circles, fine lines, and thinning skin)
Hollow cheeks and temples
Deep mouth frown lines
Decreased volume in lips
Excessive frown lines
Excessive facial wrinkles
Sun damage and pigmentation
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7.
Do you live a healthy lifestyle? Select which of the below apply to you?
(Required.)
Eat a well balanced diet, consisting of raw food and mininal / no processed food
Drink enough water
Get enough sleep
Exercise regularly
Reduce stress levels
Moderate intake of alcohol
Quit smoking / do not smoke
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8.
The skin needs regular in-salon treatments for effective anti-ageing benefits. Products alone are not enough. Have you had any anti-ageing skin treatments done?
(Required.)
Yes
No
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9.
What facial anti-aging treatments, aside from injectables, have you had?
(Required.)
Laser treatments (Laser Genesis, Fraxel Dual, Titan, Limelight)
Skin Needling
Chemical peels
Radiofrequency
Carboxytherapy
Photo Dynamic Therapy
Other (please specify)
Hydra Touch Facial
Other (please specify)
10.
The Renewal Institute now offers The Hydra Touch Facial .What does this treatment include?
Hydradermabrasion (deep cleansing and cleaning the skin)
Peel infusion (with either an AHA or a BHA)
Transdermal Mesotherapy with a hydrating serum
Skin tightening
Hydrating Mask
11.
Following a skin care regime, customised to your skin's needs, is vital to give your skin daily nourishment, corrective and protective benefits. Do you have prescribed skin care and a daily routine?
Yes
No
12.
To help prevent premature ageing the most important factor is to stay out of the sun! To protect your skin it is vital that you apply a broad spectrum SPF each and every day. Do you use daily SPF?
Yes
No
Sometimes
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13.
Would you like a Renewal Institute staff member to contact you to discuss the survey?
(Required.)
Yes
No
14.
Has your disposable income been a hindrance to you being able to do facial anti-aeging treatments?
Yes
No
15.
Please take a few moments to give a Facebook review of your experience with your treatments, therapist or branch by clicking on the relevant branch link below:
Bedfordview
Brooklyn
Cape Quarter
Claremont
Constantia
Durban
Fourways
Illovo
Irene
Morningside
Parkhurst
Paarl
Stellenbosch
Umhlanga
West Rand
Willowbridge