DEMOGRAPHIC PROFILE QUESTIONNAIRE FOR THE EVALUATION

OF PEPPERMINT OIL-TERNATEA SOAP

Instruction: Kindly fill up the following information needed. Place a check mark (√) to
the blank that corresponds to your answer from the given questions. Return to the
researchers as soon as you finished. Thank you and God bless! ☺

-Researchers
I. Personal Information

Name: ______________________ Sex: _____ Age: ____

Address: ________________________________________________________
Mobile Number: ___________________ E-mail: ________________________

II. Health and Other Condition

1. Do you have any illness? Yes ____ No ____

If Yes, please specify: _________________________________________
2. Do you have any soap allergies? Yes ____ No ____
If Yes, please specify: _________________________________________

III. Other Information

1. What is your skin type?
Dry skin___ Normal skin___
Oily skin___ Combination skin___
Sensitive skin___
2. Are you familiar with ternatea? Yes____ No____
3. Are you familiar with peppermint oil? Yes____ No____
IV. Interest
1. Are you willing to be the respondent in evaluating the effectiveness of peppermint
oil and ternatea as soap? Yes ____ No ____

Thank You and God Bless!