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Have you had a facial in the past?
Yes
No
How would you describe your skin?
Which conditions would you like to improve?
How would you rate your skin?
I Always burns, never tans
II Always burns easily, tans slightly
III Burns moderately - tans gradually
IV Seldom burn - Always tans well
V Rarely burns - deep tan
VI Never burns - deeply pigmented
Do you ever experience:
What is your present skin regimen?
Have you ever had:
Does your skin normally heal:
Fast
Scars
Pigmentation change afterwards
Have you ever used:
Have you had any of the following, past or present?
Do you smoke?
Yes
No
Do you wear contact lenses?
Yes
No
Have you ever had a reaction to:
Are you pregnant or trying to get pregnant?
Yes
No
How is your stress level?
High
Medium
Low
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