Survey

First name
Last name
Gender *
Age < 25 25 - 35 36 - 45 46 - 55 56+
Date of Birth *
dd-mm-yyyy
Address
Suburb
State
Post Code
Telephone (Home)
Mobile
Email *
Product Purchased *
Please tell us what Dr. LeWinn's product(s) did you purchase
Place of purchase
Myer
Amcal
Terry White
David Jones
Soul Pattinson
MyChemist
National Pharmacy
Chemmart
Priceline
Others - please state
Date of Purchase
dd-mm-yyyy
Skin type Normal/Dry Combination/Oily
working Status F/T
P/T
Not working
Marital status Single Married Other
Who/What influenced you to buy this product?
Pharmacist
TV commercials
Word of mouth
Special promotion
Mini samples in gift with purchase
Seen at David Jones or Myer
Mother
Web E-newsletter
Friend
Others
Magazine(s)
Australian Women’s Weekly
Marie Claire
Woman's Day
Harper’s Bazaar
Shop Til You Drop
Sunday Magazine
New Idea
OK! Magazine
Notebook
New Woman
Madison
Who Weekly
InStyle
Body & Soul
Sunday Life
PostScript
Cosmopolitan
Others
What other brands do you regularly use?
Clarins
Jurlique
Clinique
L'Oreal
Skin Doctor
Estee Lauder
Olay
Nutrimetics
Revlon
Avon
Nivea
Lancome
Ella Bache
Neutrogena
Dove
Elizabeth Arden
Mary Kay
Avene
Dermalogica
RoC
Natio
Shiseido
MD Formulation
Other - Please State
What is/are your biggest skin care concern(s)?
Fine lines
Loss of firmness
Dryness
Oiliness
Pigmentation/uneven skin tone/blotchiness
Sun/environmental protection
Dull rough skin
Sensitivity
Acne/pimples
Which Dr. LeWinn's product(s) do you use?
Cleanser
Toner
Day Cream Moisturiser, Advanced Night Cream, Firming Eye Cream, Oil Free Day & Night Cream, Vitamin A Rejuvenation Cream)
Lines Smoothing Complex range
Ultra R4 range
Puressence range
Facial Polishing Gel, Skin Renewal, Peel & Renew, Instant Beauty, Lip Enhancer, Hydration Serum
Sun Care & Body Care
Hand & Nail Care
Masque (Ultra R4 Recovery Masque, Cosmetic Lift, Line Smoothing Complex High Potency Treatment Mask)
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