Skincare Evaluation

Do you use facial skincare products?

Yes Never I only use sunscreen

What type of facial skincare products do you like?

Light weight Heavy creams/oils Depends on the season

What type of skincare routine do you prefer?

Minimalistic (cleanser, moisturizer, sunscreen) morning only Minimalistic morning and night Multistep routine as needed (Cleanser, toner, serum, daytime moisturizer , sunscreen, night time moisturizer, retinol etc.)

What type of facial cleanser do you use?

Foam-based Gel-based Cream-based(no-foaming)

How does your skin feel after cleansing?

Comfortable Dry Dry and tight

How often do you apply a moisturizer for your facial skin to feel well hydrated?

Never or only occasionally Once a day Twice a day

How oily is your facial skin?

My face is very oily My facial skin is oily in some places My skin is rough and dry

Do you suffer from any of the following?

Acne(pimples)/breakouts Facial redness and/or flushing A rash with itching, scaling, and redness

How even is your skin tone ?

My skin tone is even, I have no dark spots or pigmentation My skin tone is uneven, with dark spots and pigmentation I have freckles or dark spots and don’t want to get rid of them

How is the skin around your eye area? ( choose all that apply

I have dark circles around my eyes I have bags and puffiness under my eyes I have fine lines and wrinkles None of the above

What is your sun exposure like?

I am exposed to direct sunlight for over 3 hours per week I spend over 3 hours a week close to a window during daylight hours( including driving) I don’t spend much time in the sun

How about smoking? ( answer all that applies)

I currently smoke cigarettes or cigars I have smoked more than 50 cigarettes or cigars in my life I am exposed to secondhand smoke on a weekly basis None of the above

How many hours do you sleep at night?

Less than 7 hours 7 – 8 hours More than 8 hours

What other environmental factors are your skin exposed to? (choose all that apply)

Pollution Frequent air travel Air conditioning

Any other concerns that we can help you with? (choose all that applies)

Facial acne scars Sagging facial skin Other facial scars (not from acne) Frown lines, forehead lines, lines around eyes (crows feet)

Are you currently pregnant or breastfeeding?

Yes No

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