Name:______________________________

Your NuSkin Profile

1. Gender
□ Male
□ Female
2. Age:
□ (13-18)
□ (19-30)
□ (31-40)
□ (41-50)
□ (51-60)
□ (60+)
3. Are you pregnant?
□ Yes
□ No
4. Do you use?
□ Dermatologist Prescriptions
□ Hormone based birth control
□ Both
□ None
5. Ethnic Group
□ Asian
□ Black
□ Caucasian
□ Hispanic
□ Eastern Indian
□ Other
6. Which of the following best describes your skin?
□ Very oily
□ Oily
□ Combination
□ Dry
□ Very Dry
7. Which of the following best describes your current climate?
□ Hot/Dry
□ Hot/Humid
□ Moderate
□ Cold/Dry
□ Cold/Humid
8. Do you experience irritation when you add new products to your skin care
regimen?
□ Never
□ Rarely
□ Sometimes *
□ Often *
□ Always *
*Those with sensitive skin should use caution when trying new products. Test
products in a small area before applying to the entire face or body.

9. Are you concerned with skin coloration?

□ Yes
□ No
• Skin discoloration is defined as freckles, sunspots, age spots, or
melasma/pregnancy mask.
10. Does your skin break out?
□ Yes
□ No
□ No, but past signs still exist
11. Describe your breakouts?
□ Severe *
□ Moderate
□ Mile
*Only a doctor is qualified to treat severe acme. NuSkin products can be an
excellent compliment to what a doctor describes, but we recommend that you follow
your doctor’s advice in treating your severe break outs.
12. Do you have Rosacea?
□ Yes
□ No
*Rosacea is a skin condition that can only be diagnosed by a doctor. It is often
characterized by chronic redness of the cheeks and nose.
13. When you touch your skin, how does it feel, texture?
□ Smooth – Texture that looks or feels even, refined and soft. Free from
irregularies and roughness.
□ Rough – Texture that looks or feels coarse, uneven maybe bumpy.
14. Are you concerned about loss of firmness or sagging skin?
□ Yes
□ No
15. Do you have lines and wrinkles?
□ Yes
□ No
16. Based on your answers, which of the following is your primary concern?
□ Fine Lines and Wrinkles
□ Loss of firmness
□ Rough Skin
□ Breakouts
□ Discoloration
□ Sensitive Skin
□ I just want a basic skin care program.

17. Which of the following is your secondary concern?

□ Fine Lines and Wrinkles
□ Loss of firmness
□ Rough Skin
□ Breakouts
□ Discoloration
□ Sensitive Skin
□ I just want a basic skin care program.
18. What level of skin involvement are you comfortable with?
□ Minimal product user
(Women 0-4 products used)
(Men 0-3products used)
□ Basic
(Women 2-5 products used)
(Men 2-4 products used)
□ Moderate
(Women 5-8 products used)
(Men 5-8 products used)
□ Advance
(Women 8 or more products used)
(Men 8 or more products used)