Balance Me Recruitment Survey: Pre+Probiotic Complex Cleansing Milk + Gel Cream

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* 1. Your Contact Details

Name

Address

Address 2

City/Town

Postal Code

Country

Email Address

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* 2. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 3. Which are your main skin concerns (select 2)

Breakouts/ Congestion

Dull Skin

Dehydrated Skin

Oily Skin

Sensitive Skin

Redness

Dry Skin

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* 4. What is your ethnicity

Mixed / Multiple ethnic groups - White and Black Caribbean/ White and Black African/ White and Asian/ Any other Mixed / Multiple ethnic background

Black - African / Caribbean / Black British/ Any other Black / African / Caribbean background

White - English / Welsh / Scottish / Northern Irish / Irish/ British/ Any other White background

Asian - Indian/ Pakistani/ Bangladeshi/ Chinese/ Any other Asian background

Other ethnic group - Arab/ Middle Eastern/ Any other ethnic group

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* 5. Do you have any known allergies?

Nuts

Gluten

Soy

Essential Oil (Any)

No known allergies

Other (please specify)

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* 6. Are you pregnant?

Yes

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* 7. Are you vegan?

Yes

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* 8. By taking part in the Balance Me product panel you recognise and accept the fact that that some natural formulations, may still cause sensitivity in susceptible individuals and that Balance Me will not be held responsible for such occurrences. We encourage those with sensitive skin to perform a patch test on the skin for possible reactions, and those with allergies to notify us before agreeing to take part in the panel test.

I agree