Cosmetics Survey For Women 1. What is your age? ________ years old 2. On average, how much in US dollars would you say you spend on cosmetics products per month? $_____________ 3. Where do you purchase cosmetics products from most of the time? (Please check all that apply.) Drug stores like CVS or Walgreens  Cosmetics specialty stores like Sephora  Other (please specify): _________________________________________ 4. Of the cosmetics products you purchase, check all the product types below that you have purchased.  moisturizer  eye creams, moisturizers or serums  skin brightening products 5. On a scale of 1 to 5 with 5 being the most and 1 being the least, how much more likely are you to purchase a product if it advertises a new ingredient using nanotechnology to produce better results? Please circle one. 5 Much more likely 4 3 2 1 Not at all more likely  nighttime creams  skin firming products  Grocery stores like Kroger  Department stores like Macy’s 6. Have you purchased any cosmetic products in the past that were advertised as “antiaging” products? Circle “yes” or “no.”  Philosophy  L’Oreal  Olay  Other (please specify): _________________________________________ 8. What is your approximate gross household income in one year? Please check one. yes no  Lumene  Patricia Wexler, MD  MD Formulations 7. What cosmetics brands do you associate with anti-aging products? Check all that apply.  $15,000 or less  $26,000-36,000  $51,000-70,000  $91,000 or more  $16,000-25,000  $37,000-50,000  $71,000-90,000 9. What is your occupation? _________________________________