E-Newsletter

Place of purchase
Myer
Amcal
Terry White
David Jones
Soul Pattinson
MyChemist
National Pharmacy
Chemmart
Priceline
Others - please state
Date of Purchase
dd-mm-yyyy
Product Purchased *
Please tell us what Dr. LeWinn's product(s) did you purchase
Date of Birth *
dd-mm-yyyy
Age < 25 25 - 35 36 - 45 46 - 55 56+
Gender *
First name
Last name
Address
Suburb
Post Code
Telephone (Home)
Mobile
Email *
Skin type Normal/Dry Combination/Oily
working Status F/T
P/T
Not working
Marital status Single Married Other
Who/What influenced you to buy this product?
Pharmacist
TV commercials
Word of mouth
Special promotion
Mini samples in gift with purchase
Department stores
Mother
Web/E-newsletter
Friend
Others
Magazine(s)
New Zealand Women’s Weekly
Simply You
Next
New Zealand Woman’s Day
Cleo New Zealand
Pharmacy Today
Notebook
Marie Claire
OK! Magazine
Cosmopolitan
Shop Til You Drop
InStyle
Who Weekly
What other brands do you regularly use?
Clarins
Living Nature
Clinique
L'Oreal
Skin Doctor
Estee Lauder
Olay
Nutrimetics
Revlon
Avon
Nivea
Lancome
Ella Bache
Neutrogena
Dove
Elizabeth Arden
Mary Kay
Avene
Dermalogica
RoC
Natio
Shiseido
MD Formulation
Evolu
Trilogy
Dr. Haucshka
Matis
Other - Please State
What is/are your biggest skin care concern(s)?
Fine lines
Loss of firmness
Dryness
Oiliness
Pigmentation/uneven skin tone/blotchiness
Dull rough skin
sensitivity
Sun/environmental protection
Acne/pimples
Which Dr. LeWinn's product(s) do you use?
Cleanser
Toner
Day Cream Moisturiser, Advanced Night Cream, Firming Eye Cream, Oil Free Day & Night Cream, Vitamin A Rejuvenation Cream
Line Smoothing Complex range
Ultra R4 range
Puressence range
Facial Polishing Gel, Skin Renewal, Peel & Renew, Instant Beauty, Lip Enhancer, Hydration Serum
Sun Care & Body Care
Hand & Nail Care
Masque (Ultra R4 Recovery Masque, Cosmetic Lift, Line Smoothing Complex High Potency Treatment Mask)
Please confirm if you would like to receive promotional updates & information on Dr. LeWinn’s Yes
No

Dr Lewinn's International | Privacy Policy | Terms & Conditions | Contact Us
Website Developed By Flirt Creative