Skin Analysis

Want to a personalized skin care regiment to ensure that your skin gets the best possible protection and care while you are playing golf? All you need to do is fill out this form and send it to us and well do an analysis of your skin care needs, prepare a personalized skin care plan just for you and also send you a free sample of our Illuminate & Hydrate Moisturizer with SPF30.

All it takes is a few minutes to get the best golfing skin care available.

Name
Address
Address 2
City
State	Select AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TT TX UT VA VI VT WA WI WV WY YT BC AB SK MB ON NB QC NS NF
Zip
Email
How did you hear about us?
Age:	Select 18-25 26-40 41-55 56-70 70+
Skin Tone	Select Very Fair Blonde or Redhead Freckles, Burns easily Fair - Blonde, burn turns to tan Medium - Light brown hair, hazel eyes, sometimes burn Olive - Darker skin, Hispanic or Asian, rarely burns Dark - Dark hair and eyes, African-American, rarely burn
Skin Type	Select Very Oily Oily Dry Combination Normal
Do you:	Exercise regularly Sleep well Eat healthy Spend time outdoors Use sunblock Spend time with friends Laugh Smoke Drink alcohol Have allergies
Do you use:	Retin A Accutane Birth Control Diet Drugs Caffeine Tanning Booths
Are you pregnant or trying to get pregnant?	Yes No
Do you wear glasses?	Yes No
Your Skin Quality:
Fine Lines	Yes No Some
Deep wrinkles	Yes No Some
Dry skin	Yes No Some
Age Spots	Yes No Some
Puffiness around the eyes	Yes No Some
Dark circles under the eyes	Yes No Some
Large pores	Yes No Some
Small pores	Yes No Some
Thin skin	Yes No Some
Uneven skin tone	Yes No Some
Oily skin	Yes No Some
Blackheads	Yes No Some
How often do you play golf how many hours a week?
What time of day do you normally go out on the course?
What is the average temperature?	20-30 F 30-40 F 20-30 F 30-40 F 20-30 F 30-40 F
Are conditions normally	Dry Windy
What skin care line do you use now?
Please describe briefly your biggest skin care concerns:
What are you looking for most in a skin care line?
Verification Code