Acne Questionnaire

This questionnaire of your skin enables us to evaluate your skin condition and acne type and grade correctly.

To analyze your specific situation and create the perfect strategy for you to get your skin back to normal, we need four digital photos of your skin.

You can take the pictures with your smart phone. There are simple rules to follow:

  • Take the pictures in good lighting
  • Do not use flash
  • Make sure that your pictures are well-focused and they are not fuzzy or blurry


Be as complete as possible, especially about the products that you are using. We need to know if there are comedogenic ingredients in the products you are currently using that might be clogging your pores and exacerbating your acne.

 female male

Check if you are allergic to:
 sulphur aspirin

Have you ever had bad or allergic reaction to anything you have ever put on your face? *

Are you currently pregnant or nursing? *

 Blackheads Dark Spots Razor Bumps Cysts Pimples/Pustules Bumps or Pebble Under the Skin Milia Shaving Irritation Age Spots Broken Capillaries Dry, Flaky Skin Oily Skin Fine Lines/Wrinkles Dehydrated Skin

 Oily Normal Dry Combination

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