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					    Client Profile ___Yes, I want in the drawing!                               Double chance by booking my own Spa tonight!

                               PERSONAL INFORMATION:
Date:___________________                        Spa Hostess:___________________________
Last Name: _____________________________ First: ____________________________________
Address: ___________________________City: _______________ State: _____ Zip:_____________
Cell: ________________ Home: _______________ Work: ______________ Best Time To Call: ________ am/pm
Email: ______________________________________________@__________________________
B’day Month ______ Anniversary Month: _________ Spouse:_______________ Phone:_____________________
                                  Age Group a mirror and 30-39 40-49 50+
Are you a mom? Y / N Take a quick glance in (circle): 18-29 answer a few questions:
Socialyou could change anything about your skin, what would it be? (What do you want help fixing?)etc..): __________________
1. If Groups You Are In That Might Enjoy a Spa Session (ie book club, garden club, wine club, pta/moms club
Check ALL that apply:
2. What are you currently doing/using to Maintain, un-employed ◊ your skin? ◊ brand, regimen?)
◊ domestic goddess ◊ employed ◊ retired ◊Repair, and ProtectPart-Time (ie:Full-Time ◊ I want to change jobs
◊ could use some extra cash each month for everyday expenses
3. What do you like about it? ______________________________________________________________________________
Employer: _______________________________________Title: ________________________________________
4. What don’t you like? (cost, not convenient, not simple, no personal service) ______________________________________

                                                        Skin Concerns:
My Facial Concerns Are:
◊ very dry                     ◊ very oily                      ◊ fine lines & wrinkles                   ◊ large pores
◊ occasional acne              ◊ chronic acne                   ◊ puffiness face                          ◊ chapped lips
◊ fine lines/lips              ◊ rough texture                  ◊ blackheads                              ◊ loss of firmness
◊ age spots/freckles           ◊ sun protection                 ◊ Resaca/sensitive (products burn me)     ◊ scarring

My Eye Concerns Are:
◊ crows feet/lines            ◊ dark circles            ◊ puffiness            ◊ sagging eye lids/brow

                                                      Makeup Concerns:
◊   I want a new look & to know my best colors &/or I need application tips.
◊   I need a lipstick that stays put w/out drying &/or a new color                     I currently use: ____________________
◊   I need a great eye makeup remover.                                                 I prefer: Foundation ____Liquid
◊   I want makeup to last longer                                                                             ____Power
◊   My eye liner smudges                                                                                    ____Creme
◊   My mascara smudges / need waterproof                                                _____I want to try your Mineral!
◊   I want to cover up: red patches/dark circles/yellow
◊   Interested in Anti Aging Makeup

                                                          Body Concerns:
My body:
◊   sun protection for the body             ◊ dry skin/itchy skin
◊   age spots/freckles                      ◊ body acne
◊   cellulite                               ◊ stretch marks
◊   keeping bra straps in place◊ want to   tighten skin on body
My hands & feet:
◊ dry/damaged cuticles      ◊ dry hands        ◊ dry/damaged feet     ◊ calluses

I enjoy bath & body products:
◊ Body washes       ◊ Body scrubs     ◊ Body Masques         ◊ Bath Products    ◊ Scented Lotions &/or Perfume
   MY BEAUTICONTROL WISH LIST: Things I am Interested in That I Enjoyed Tonight
                       Skin Care MRP                                                 I want to fix my lips:
 I want GREAT skin:                                              o Lip Apeel Scrub & Balm (for chapped dry lips)
 ◊ skin care cleansing set (cleanser, scrub, tonic,              o Platinum Anti Aging Lip Treatment
 moisturizer)                                                      (for lines & aging lips)
 I want to FIX my skin problems:                                 o Secret Agent Lip Primer
 ◊ TFF aka botox in a bottle                                       (fills lines so lipstick doesn’t run)
 ◊ Microderm Abrasion buffer & creme
 ◊ (age specific) eye repair crème
 ◊ Retinol Eye Capsules (for deep PM repair)                                       Spa Product Wish List:
 ◊ Retinol Face Serum (for deep PM repair)                       Spa for Face:
 ◊ Cell Block C Brightening Elixir                               □ Green Tea Masque (warming masque)
 ◊ Chemical Peel (for large pores)                               □ Cucumber Eye Pads (for itchy, dry eyes, headaches)
 ◊ Platinum Eye Patches (a 24 hr eye lift/fix)                   □ Luxuries of Sea Mud Masque for face & body
 I want to prevent future damage/aging:                          □ Herbal Hydrating Mist
 ◊ Cell Block C SPF                                              Spa for Body:
 ◊ Cell Block C PM (for after Microderm Abrasion)                □ Detox Peppermint Bath Soak/Aromatherapy
  (if in 50+ line it would be your night crème in your             (for arthritis, aching muscles, headaches & sinuses)
 maintenance set)                                                □ Anti Ash Crème (pantyhose in a bottle for shiny legs)
 ◊ Cell Block C Intensive Multi-Vitamin Capsules                 □ Awaken Body Line (grapefruit, lime, citrus)
                                                                 □ Relax Body Line (lavender, chamomile)
                                                                 □ Featured Seasonal Line: ________________________
         I Use/Like the Following Types of Makeup:               Spa for Hands:
 ∆ Primers        ∆ Concealers             ∆ Wrinkle Deflector   □ Show of Hands Instant Manicure Scrub & Hand
                                                                    Crème (for damaged cuticles and hands)
 ∆ Foundation     ∆ Shadow Control         ∆ Eye Shadow
                                                                 Spa for Feet:
 ∆ Eye Liner       ∆ Lash/Brow Cond        ∆ Mascara             □ Save Your Sole Salve (blue salve/putty for cracks in
                                                                    heels and dry feet)
 ∆ Blush           ∆ Bronzers              ∆ Lipstick            □ Margarita Foot Crème (for dry feet & arthritis)
 ∆ Lip Gloss      ∆ Lip Line Filler   ∆ Eye Makeup Remover       □ Herbal Serenity Foot Crème (peppermint melon)

             *~*~*~*      ___Yes, I want in the drawing! *~*~*~*
             ___Double my chances, I Want to Book my own Spa tonight!
         My Name:________________________________phone#(___)___________
                Email: ________________________@_______________
                  People that I enjoy receiving gifts from and occasion
Person                          Occasion                                  Phone#

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