1. Have you visited Skin Essentials? Yes No --

(if yes, please complete the other parts of Question 1)

   1a. When did you last visit Skin Essentials?

   1b. Please rate your visit: ---- 10 - highly satisfactory 9 8 7 6 5 4 3 2 1 - unsatisfactory

   1c. What did you like about your visit?

   1d. What would you suggest we do differently on your next visit?
         

   1e. Your visit was due to: --- a referral a gift certificate an advertisement other

2. Do you frequent another Day Spa? Yes No --

3. If so , where?

4. Are you on our email list which includes special offers such as openings at a discounted rate, our newsletter and more? --- Yes No
(If you are not yet on our email list, you may sign up just by having a check in the box to subscribe.)

Subscribe to mailing list:

Notify me if my subscription is successful?

5. Would you like to be on our short notice list? --- Yes No
In the event we have a cancellation, we refer to our short notice list to fill the available appointment. By adding your name to our list, you will have the opportunity to fill a short notice vacancy when we call.

6. Please Select One I only visited the site for the survey I browsed through the whole site I only browsed through the links that interested me

7. What would you like see added to our menu or website?

8. Have you heard of our referral program? --- Yes No
      If not, click here to read about our referral program.

9. After reviewing Skin Essential's Website, I would rate it -- 10 - Wonderful! 9 8 7 6 5 4 3 2 1 - I don't care for the site I didn't browse the site

Comments? Questions? Please use the area below:

Please provide the following:

**Name:

Phone:

**E-mail: