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Skin and Skincare Questionnaire

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

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

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

  • Do not use flash.
  • Make sure that your pictures are not fuzzy or blurry.



    Check if you are allergic to:

    Are you presently taking birth control pill?

    Are you using any prescription topicals from the dermatologist, i.e. steroids, retinoids, Accutane, Hydroquinone, RetinA, Tazorac, etc.

    Do you undergo laser hair reduction, laser skin treatments, electrolysis, or chemical peels?

    What are your skin concerns?
    BlackheadsWhiteheadsDark spotsAge spotsRazor bumpsDry, dehydrated skinFlaky skinSensitive skinOily skinFine lines/wrinklesDeep or permanent lines/wrinkles

    Skin Type Information

    • face1nose only (if any at all)

    • face2from the center of the face to the inner corner of the eye

    • face3from the center of the face to inner corner of iris

    • face4from the center of the face to the middle of the eye

    • face5entire face

    NeverIn 10-12 hoursIn 7-9 hoursIn 4-6 hoursIn 1-3 hours


    FlakySmoothShinyI don’t wear make up



    Yes, sever caseYesNoI don’t think so

    Skin Pigmentation Information

    NoneOneA fewA lotn/a (because I am male, or have never been pregnant or taken birth controls pills or HRT)

    NoIt went awayYesn/a (because I am male, or have never been pregnant)

    NeverA fewA lot

    NoSlightly noticeableVery noticeable