Skin Aging Attitudes and Values QuestionnaireAll information provided will be kept confidential. Name * First Name Last Name How did you hear about Bellantz? Social Media Please select which social media platform you use the most. Facebook Instagram Twitter LinkedIn Are you satisfied with your skin? What about your skin makes you the happiest/saddest? How have you tried to improve your skin in the past? What do you believe about improving your skin has worked the most? Do you believe that you look your age? If no, what age do you think you look and why? What do other people say about your looks? (i.e. you don’t look your age) How do you feel about growing older? How do you feel about looking older? Do you think your mother ages/aged well? Yes/No Do you think your paternal or maternal mother or grandmother aged well? Yes/No What is the single most important part of your skin you would like to improve? How confident do you feel that Bellantz can help you with your aging concerns? Please briefly describe. Do you have regular routines in your life that you are committed to on a daily basis? How do you stay motivated to continue these daily routines? Please describe what you would like to get out of the Bellantz's Face Enhancing Fitness Program program. Thank you!
