How would you classify your skin tone?
What is your primary skin concern?
Do you have dark circles under your eyes?:
What is your age?
What is your gender?
Your face appears shiny in photographs
Never, or you’ve never noticed the shine
How does your skin feel when you don't apply a moisturizer or sunscreen in a low-humity environment?
Feels very dry or cracks
Looks shiny, or I never feel that I moisturise
How would you describe your facial skin as?
How does your skin feel after cleansing?
Feels dry or cracks or I do not use soap or other foaming cleansers
Feels slightly dry but does not
How often do you experience an oily T-zone (forehead and nose)?
Have you ever been diagnosed with acne or rosacea -tri-add skin?
Friends and acquaintances tell me I have it
Yes, a severe case
Have you ever developed a rashor irritation towards jewelry?
How often do sunscreens or fragranced products make your skin itch, burn, break-out, or turn red?
How often does your face look red in photographs?
Never, or I’ve never noticed
Have you ever been treated for an allergy?
What is your natural hair colour? (colour before graying)
When exposed to sun for the first time in several months, your skin:
Burns then gets darker
My skin is already dark so it is hard to see if it gets darker.
Do the dark spots on your face darken when you go in the sun?
I have no dark spots
A lot worse (if you use sunscreen everyday please select D)
How many dark spots did you develop on your face when you were pregnant, on contraceptives, or taking hormone replacement therapy(HRT)?
Do you experience scarring or pigmentation after a pimple or breakout?
Do you have facial wrinkles?
No, not even with movement
Only when I move
Yes, movement and at rest
Wrinkles always present
Over your entire life, how many cigarettes have you smoked (or been exposed to)?
several to many packs
Several to many packs
I smoke every day
Please describe the air pollution where you reside:
The air is fresh and clean
For part of the year, but not all of the year, I reside in a place with clean air.
The air is slightly polluted
The air is very polluted
Please describe the length of time that you have used retinoid facial creams such as Retinol, Renova, Retin-A, Tazorac, Differin, or Avage:
Once for acne when I was younger
Based on the places you’ve lived, how much daily sun exposure have you received in your life?
Little; I’ve mostly lived in places that are gray and overcast.
Some; I’ve lived in less sunny climes at times, but also in places with more regular sun
Moderate; I’ve lived in places with a fair amount of sun exposure.
A lot; I’ve lived in tropical, southern, or very sunny locales.
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