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Skin Health Assessment

Let us help you choose the right products for your specific skin needs and/or concerns. Fill out the assessment below and we will help you choose the best possible products for your skin needs. It can take up to 48 hours to receive your product recommendations.

If you have any questions about your skin please submit your questions to us at Ask the Expert. Allow 24-72 hours for a response. We look forward to helping you on your journey to healthy skin.

Personal information

Your name

Your email address

Your phone number

Sex

Male

Female

Your age

Information about your skin type

What level of skin dryness do you experience?

Areas of dryness

Time of year that dryness is the worst

What level of skin oiliness do you experience?

Areas of oiliness

What level of skin sensitivity do you experience?

Areas of the face which are most sensitive

Do you experience acneic breakouts?

Yes

No

What best describes the severity of your breakouts?

List the areas of you are experiencing breakouts

What type of breakouts do you experience?

Blackheads

Cystic

Pustules

Papules

Please check all that apply

What are you pores like?

Normal

Clogged

Enlarged

Please check all that apply

Do you suffer from acne scarring?

Acne scars

Pigmented acne scars

Indented acne scars

Please check all that apply

What best describes the texture of your skin?

Do you suffer from Rosacea?

Yes

No

What best describes the severity of your Rosacea

Please tell us about your Rosacea

What best describes your level of sun exposure?

Please provide some details about your sun exposure

Do you wear sunscreen?

What type of sunscreen do you wear and how long have you used it?

Do you suffer from Hyperpigmentation or Sun Spots?

Yes

No

What area(s) of your body do you have spots?

How long have you had the spot(s)?

Is it Melasma?

Are you experiencing any of these signs of aging?

Fine lines and wrinkles

Crow's feet

Smile lines

Frown lines

Lip lines

Forhead lines

Loss of tone and elasticity

Tired looking skin

Sallow looking skin

Please check all that apply

Are you experiencing any of these common eye area concerns?

Dark circles

Puffy eyes

Sagging eye lids

Please check all that apply

Skin Treatment and Skincare History

Have you had laser resurfacing done in the last 6 months?

Yes

No

Have you had any chemical peels in the last 30 days?

Yes

No

What type of peels did you have?

Have you had any injections in the past year? (botox, restylene etc...)

Yes

No

Have you ever had a face lift?

Yes

No

Have you undergone any other invasive treatments in the past six months?

Yes

No

Please list the other treatments you have undergone here

Will you be undergoing any other treatments or surgeries in the next 30 days?

Yes

No

What treatments or surgeries will you be undergoing?

Are you currently using any Retin A products?

Yes

No

Are you using any prescription drugs either topical or internal?

Yes

No

Please list all skincare products you are currently using

Do you have any skin allergies?

Yes

No

Please tell us about your allergies

Have you had a negative reaction to any skincare product you've used in the past?

Yes

No

Please describe the reaction you had as well as the skincare product

Do you have any known food allergies?

Yes

No

Please list your food allergies

Are you allergic to aspirin?

Yes

No

Please list any other important information about your skin or health

What are your top 3 skin goals?

Please type in the words you see below

Don't worry, if you make a mistake your form will not be erased.

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