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Consultant Survey

A client intake survey used before a skin and hair care consultation, covering allergies, current routines, and preferences so the consultant can recommend the right products and treatments.

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In the Claude connectors directory

Name

First Name

Last Name

Phone Number

Address

Street Address

City

State / Province

ZIP / Postal Code

Date

Education

High School Associate Degree Bachelor's Degree Master's Degree Doctorate

Check any interests that you like:

Skincare Haircare Makeup Spa Treatments Wellness

Any known allergies to skin/cosmetic products?

Please describe your skin care routine

Duration

Less than 1 year 1 to 3 years 3 to 5 years More than 5 years

Skin type

Oily Dry Combination Sensitive Normal

Skin tone

Fair Light Medium Tan Dark

Favorite skincare brand(s)

Do you have extremely dry skin?

Yes No

Do you have lines/wrinkles compared to peers?

Yes No

Do you have uneven skin tone?

Yes No

Do you have redness?

Yes No

Do you use sunscreen? If yes, what SPF?

SPF 15 SPF 30 SPF 50 SPF 50+ I don't use it

Are there any particular ingredients you avoid in hair and skincare products? If yes, explain:

Yes No

What type of hair do you have?

Straight Wavy Curly Coily

Do you have scalp problems?

Yes No

Please give details

Have you had any side effects from hair or skincare products? If yes, explain:

Yes No

Please give details

Please briefly describe your hair care routine

How often do you buy hair and skincare products?

What products do you use?

In a typical week, how many different types of hair and skin care products do you use (shampoo, conditioner, mousse, treatment, hair spray, grease, gel, stylers, lotions, body wash)?

How do you select products?

Gender

Female Male Other Prefer not to say

Age

Under 18 18-24 25-34 35-44 45-54 55+

Any further explanation or concerns? (use the space below)

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