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1. What best describes your skin?

2. Is one of these a problem for you?

3. How often do you break out?

4. Do you shave most or all of your face?

5. Is your beard particularly coarse?

6. Do you use products that contain any of the following?: Check all that apply.

7. What type of cleanser do you use? Check all that apply.

8. Do you use toner or aftershave?

9. Do you use moisturizer?

10. Are you on any prescription medication for acne or rosacea or do you use products with benzoyl perox

11. How do you remove your cleansing products?

12. What is the climate like where you live?
13. What would you like to improve about your skin? Check all that apply.

14. How did you hear about us?

15. Do your currently use Simone France products?

16. Please list any allergies, sensitivities or other information we should know about your skin.