Custom Made Natural Skin Care Submission Form

Natural skin care products by Wildcrafted Herbal Products

WILDCRAFTED HERBAL PRODUCTS

Your Natural Skin & Personal Care Solution


Natural skin care products by Wildcrafted Herbal Products

Have Your Own Customised Natural Skin Care Products

Natural Skin Care Products by Wildcrafted Herbal Products

Introduction

This form is the first step to having your very own, personalised custom made natural skin care products. If you like, you can even have your own name on the label. Please read the instructions above the form and answer all the questions. The more information you can give our formulation team, the more effective your skin care products will be.

Custom Made Skin Care Form

 

Customised Natural Skin Care Products Formulation Form

About the Submission Form

This form is the first step to your own custom made natural skin care range. By filling in this form you are not committed in any way to make any purchase of any kind.

Once we have received your completed form, we will send you an email. This email will provide you with the cost of the products you have requested. It will also contain one or more links to a secure shopping cart where your order can be placed.

In this email we may ask you for more information in order to provide you with the best possible formulation of your skin care products.

The Process

Should you wish to go ahead and place your order, our email to you will provide a link which will take you to our shopping cart. From there you can then click on 'go to payments' then, just follow the prompts. You will be transferred to a secure server to make your credit card payment.

Once we receive confirmation of your order and your purchase has been approved, we will notify you via email and inform you of approximately how long it will be before you will receive your products. We will send you a second email on the day your order is dispatched.

Your Information is Strictly Confidential and Treated as a Medical Record

Please fill in this form and provide us with as much information as you can. This is the only way for us to be able to make your natural skin care products to match your needs. The more information we have the better your products will work for you.

Any information you supply is treated with the strictest confidence.
Only the formulation team will have access to this information and this information is stored with our patient files for security.
Your information will be treated as a medical record - available to no one.

Should you no longer wish Wildcrafted Herbal Products to make your customized skin care products for you, your information will not be kept or used in any way. It will be deleted from our system and files.

Contact Details:

Your Name:


Your Email Address:


Your Mailing Address:


Contact phone number (if outside Australia, please include country and area codes):



Please answer the following questions. They are important in order to formulate your skin care products for maximum effectiveness.

General Information:

Age:


Gender:


Cultural skin type:  e.g.: African American, Hispanic, Anglo-Saxon etc.


About your skin types:

Skin types may include:
  • Normal
  • Normal to dry
  • Dry
  • Dry and sensitive
  • Oily
  • Sensitive
  • Mature and sensitive
  • Mature, dry and sensitive
  • Oily to normal
  • Various combinations of the above.
     If you do not know your skin types or you need more information visit our "What's my skin type" page before you fill in the boxes below.
 
Primary Skin Type:


Secondary Skin Type:


Other skin type(s):


Specific problems with your skin:

Skin problems (please tell us of any problems you are having with you skin - medical; for example,  Psoriasis, Acne, Dermatitis,  etc.


Please provide us with information on any medication you are currently taking or have recently been taking. (please include medication that is not necessarily for a skin disorder, such as high blood pressure medication, medication for arthritis etc.

Medication (Natural or Pharmaceutical):


Do You Have Any General Health Issues:


Other information about your skin you feel we need to know in order to provide you with the best formulation of your skin care products?



Lifestyle

Do you smoke? - Yes   No   

Do you suffer from any allergies? - Yes   No   

If Yes, please specify the type of allergy, how severely you suffer from it and for how long you have had this allergy:



Do you take any medication for this allergy?  -  Yes   No   

What is the Brand - Name of the medication - Dosage of the Medication:



Is your skin particularly sensitive to anything? (For example: wool)  -  Yes   No   

If Yes, what is it?



Other information about your LifeStyle you feel we need to know in order to provide you with the best formulation of your skin care products?



Type of Skin Care Products you would like  formulated:

Please indicate which products you would like in your natural skin care system. We will formulate the products to enhance each other for maximum effectiveness.

Exfoliant  -  Yes    
Face Mask  -  Yes  
Body Wrap  -  Yes  
Cleanser  -  Yes  
Toner  -  Yes  
Moisturiser  -  Yes  
Hydrator  -  Yes  
Age Defying Essence  -  Yes  
Eye & Lip care product  -  Yes  
Other  -  Yes    
 

If you would like us to make a product other than listed above, please indicate this below:


Please select the product Type (e.g.: Toner), Base (this is the medium to which the active ingredients are added), and  Fragrance (how you would like it to smell).

Note: you do not have to select a base or fragrance, if you 'd prefer to let Wildcrafted's formulation team make the choice for you.


Toner
  -  Yes     

Base:
  • Do you want your  Toner in a lotion base (recommended) - Yes   or
  • Do you want your  Toner in a creme base -  Yes   or
  • Do you want your  Toner in a gel base -  Yes   
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance - Yes

Moisturiser  -  Yes  

Base:
  • Do you want your  Moisturiser in a lotion base - Yes   or
  • Do you want your  Moisturiser in a creme base -  Yes   or
  • Do you want your  Moisturiser in a gel base -  Yes   or
  • Do you want your  Moisturiser ... -  Yes  
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes  


Age Defying Essence  -  Yes  

Base:
  • Do you want your  Age Defying Essence in a lotion base (recommended) - Yes   or
  • Do you want your  Age Defying Essence in a creme -  Yes   or
  • Do you want your  Age Defying Essence gel -  Yes   or
  • Do you want your  Age Defying Essence ... -  Yes  
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance - Yes

Face Mask (Clay)  -  Yes  

Base:
  • Do you want your Face Mask in a clay base -  Yes   or
  • Do you want your Face Mask in a gel base -  Yes
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes

Exfoliant scrub  -  Yes  

Base:
  • Do you want your  Exfoliant scrub in a lotion base - Yes   or
  • Do you want your  Exfoliant scrub in a creme -  Yes   or
  • Do you want your  Exfoliant scrub dry (mix with water) -  Yes
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes


Shower Body Wash  -  Yes  

Base:
  • Do you want your  Shower Body Wash in a lotion base - Yes   or
  • Do you want your  Shower Body Wash in a creme -  Yes   or
  • Do you want your  Shower Body Wash in a gel -  Yes  
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes


Gentle Eye and Lip Care Product  -  Yes  

Base:
  • Do you want your  Gentle Eye and Lip Product in a lotion base -  Yes   or
  • Do you want your  Gentle Eye and Lip Product in a creme -  Yes   or
  • Do you want your  Gentle Eye and Lip Product in a gel -  Yes
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes  


Ginseng Hydrator  -  Yes  

Base:
  • Do you want your Hydrator in a lotion base -  Yes   or
  • Do you want your Hydrator in a creme base -  Yes   or
  • Do you want your Hydrator in a gel base -  Yes   
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes


Body Wrap  -  Yes  

Base:
  • Do you want your Body Wrap in a lotion base -  Yes   or
  • Do you want your Body Wrap in a creme base -  Yes   or
  • Do you want your Body Wrap in a gel base -  Yes   
Fragrance:
  • No fragrance -  Yes   or
  • Woody fragrance -  Yes   or
  • Floral fragrance -  Yes



Other - Please indicate what kind of product you would like. We will contact you on the email address you provided above to seek further information, if required.


 


 

 

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Natural Skin Care
Treat Your Skin to the Best Nature has to offer.

 

Looking for Natural Skin Care?
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Want Chemical-free, Natural Skin Care?
Choose Wildcrafted Herbal Products to Look After Your Skin Naturally.

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WILDCRAFTED HERBAL PRODUCTS
ABN 97 131 307 643

P.O. Box 111
Kurmond, NSW, 2757
Australia

email: Contact
phone: +61 2 4573 0784 - international
phone: (02) 4573 0784 - within Australia

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