SYRES Singapore
Panelist Enrolment Sheet

Welcome and congratulations !

You are about 5-10 minutes away from being a registered panelist.

Although the questionnaire asks many questions on cosmetics, men are also most welcome to enrol as we do tests on male skincare products too.

The first part of the questionnaire is compulsory for enrolment. If you could spare a few more minutes, we would appreciate you letting us know more  about you in the second part of the questionnaire. 

Last but not least, we welcome all comments from you at the end of this document. 

PART I (Compulsory)

Your personal details 

Surname       Name       NRIC

DOB DDMMYY     

Address                     
                                  

Postal Code        S ( )                  

Tel Office                  

Tel Home                  

Tel Mobile                 

E-mail                      

Race      Chinese           Malay            Indian           Other   
 

Recruited through  Ad    via Surname, name 

Have you participated in such consumer tests before ? no    yes    
Which ?   

Can you come to our offices to pick up your sample products between 9 am & 7 pm ?
  yes  no   

Your occupation ?

What is your field of activity   ?        
(i.e. governement, education, banking, manufacturing, trade, etc... )

1-BODY

1a - The skin of your body is :

   

	Very dry			Normal to dry		Oily
	Dry			Normal		Mixed
				Normal to oily

                                           

Is the skin on your body sensitive ?		yes		no
Do you have some cellulite ?		yes		no

1b - Which Body Care products do you use ?

 

	Y	N			Y	N
Moisturizer				Body Scrubs
Skin Firming				Sun Screens
Skin Slimming				Body Oils

1c - Which hair removal method do you use ?

 

	Y	N			Y	N
Razor				Cream
Wax				Other
Wax Strips				which ?

                                                          

1d - Where do you buy these Body Care products most often ( Max 2 answers ) ?
                                                  

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

2 - FACE
 

2a - The skin of your face is :

  

	Very dry			Normal to dry		Oily
	Dry			Normal		Mixed
				Normal to oily

 

Is the skin on your face sensitive ?		yes		no
Do you have some wrinkles ?		yes		no
Do you have some fine lines ?		yes		no
Is your skin losing its firmness ?		yes		no
Do you have some acne ?		yes		no
Do you have some pimples ?		yes		no
Do you have some blemishes ?		yes		no
Are your eyes sensitive ?		yes		no
Do you wear contact lenses ?		yes		no

2b - Which Face Care products do you use ?

Do you follow a routine ?     yes      no 

2c - Where do you buy these Face Care products most often ( Max 2 answers ) ?

    

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

3 - COMPLEXION MakeUp

3a - How often do you apply make-up ?

3b - Which make-up products do you use for your complexion ?

3c - What type of make-up do you use most often ?

3d - Where do you buy these Complexion make-up products most often ( Max 2 answers ) ?

 

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

4 - MAKE UP

4a - Which make-up products do you use most often for your eyes ?

4b - Which types of mascara do you use most often ?

4d - Where do you buy these Eyes & Lips make-up products most often ( Max 2 answers ) ?

 

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

4e - Which make-up products do you use on your nails ?

4f - Where do you buy these Nails make-up products most often ( Max 2 answers ) ?

 

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

5 - MAKE UP REMOVER

5a - Which make-up remover do you use most often for your eyes ?

5b - Do you use make-up removers that rinse off with water ?

yes   no 

5c - Which products do you use for the removal of your make-up (am & pm ) ?

5d - Where do you buy these Make Up Remover  products most often ( Max 2 answers ) ?

 

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

6 - HAIR

6a - Your hair condition is ?   
 

	Oily			Normal to dry
	Normal to oily			Dry
	Normal			Oily roots - dry tips

6b - Your hair length is ?  

 

	Very short			Long
	Short			Very long
	Shoulder length

6c - The nature of your hair is ?   

 

	Straight			Curly
	Supple			Frizzy
	Wavy			Afro

6d - Your hair is  ?  

 

	Fine
	Normal
	Thick

6e - You have  ?   
 

	Not so much hair
	Normal
	A lot of hair

6f - Your hair scalp is ?    

6g - Which types of shampoos do you use ?

6h - Where do you buy these Hair Care  products most often ( Max 2 answers ) ?

 

	Choice #1	Choice #2
Supermarkets (Giant, NTUC,..)
Department Stores (Takashimaya, Metro,..)
Pharmacy/Chemist/Specialty (Guardian, Apex,..)
Perfumeries (L'Occitane, The Body Shop,...)
Mail Order
Beauty Parlor

Thank you, you may proceed to the bottom of the page to submit your responses.

But, if you have more time, you may complete Part II to let us know more about you.

                                                                                                                                                  

PART II  (Optional)

7 - More questions about your household :

7a - How many people in your household ?   

7b - Children

Child1       M F           DOB DDMMYYYY  

Child2       M F           DOB DDMMYYYY  

Child3       M F           DOB DDMMYYYY  

Child4       M F           DOB DDMMYYYY  

Would you accept that they participate in our tests ?     yes no

8 - More questions about your hair :
 

8a - What kind of problems do you have with your hair ?

                                                     
8b - Your hair color/style is natural ?
 

yes

no

If NO, is it ?

8c - Which other hair care products do you use ? 

 

	Y	N			Y	N			Y	N
Hair Conditioner				Hair Mask				Lotion
Detangling Balm				Beauty Cream				Leave-In Conditioner

8d - Which types of styling products do you use ? 
 

	Y	N			Y	N			Y	N
Fixing Gel				Foam				Spray
Lacquer				Styling Water				Styling Wax

9- Which brands do you buy most often ?

Dear Panelist, we would now like to know more about your brand usage for various types of personal care
products. The brand names listed correspond to market leaders at some point in time.
If your brand of preference is not on the list, click "other" and fill in with the name of your brand.