Online Skin Analysis

About you

1. Name
1a. Email
2. Country of Residence
3. What suburb do you live in
4. Do you live in a dry or humid Climate?
5. Race/Nationality
6. Date of Birth
7. Age
8. Occupation

About your skin

What cosmetics do you currently use on your face (brand and product name)?

9. Cleansing
10. Toning
11. Moisturising
12. Specific Serum or Correctors
13. Eye & Lip Creams/Gels
14. Sun Protection
15. Mask
16. Scrubs/Exfoliating
17. Medicated creams
18. Shampoo
19. Conditioner
20. Foundation
21. Concealer
22. Blush
23. Bronzer
24. Lip & Eye Products
25. Anything else like pre foundation primers, luminizers etc.

Describe your skincare routine

About your general health

Do you have any of the following skin conditions?

Check any of the following skin conditions that you suffer and answer the appropriate questions as indicated. After answering these questions you ONLY have to answer the other INDICATED questions, No additional ones.


47. Very sensitive/reactive skin	Yes - answer questions 56 - 61
48. Acne or pimples	Yes - answer questions 62 - 66
49. Pigmentation (brown marks like sun spots)	Yes - answer questions 67 - 70
50. Broken capillaries (red marks)	Yes - answer questions 71 - 74
51. Acne Rosacea (red aggressed skin with pimples usually on the cheeks)	Yes - answer questions 62 - 66
52. Dermatitis (scaling and itching)	Yes - answer questions 75 - 78
53. Excessive dryness and flaking	Yes - answer questions 79 - 82
54. Excessive oiliness	Yes - answer questions 83 - 86
55. Skin flushing/going red easily	Yes - answer questions 87 - 90

About sensitive/reactive skin

56. How long has your skin been sensitive/reactive?
57. What brands and products have you reacted to in the past?
58. Does the heat make your skin sensitive?
59. Does your skin react when you eat spicy food?
60. Have you had any particular treatments to treat your skin condition? If Yes elaborate…	Yes - explain below
61. Other comments about your sensitive skin

About pimples & acne

Acne/Pimples – If you suffer from acne or pimples appearing more than just once a month answer the following questions.

About pigmentation/brown marks

67. How long have you suffered this skin condition?
68. Describe what areas of your face are affected
69. What else can you tell me about your skin condition (ie: it came up after pregnancy)?
70. Have you had any particular treatments to treat your skin condition? If Yes elaborate

About broken capillaries/red marks

71. How long have you suffered this skin condition?
72. Describe what areas of your face are affected
73. What else can you tell me about your skin condition (ie: when I smoke it gets worse)?
74. Have you had any particular treatments to treat your skin condition? If Yes elaborate

About dermatitis

75. How long have you suffered this skin condition?
76. Describe what areas of your face are affected
77. What else can you tell me about your skin condition (ie: when I smoke it gets worse)?
78. Have you had any particular treatments to treat your skin condition? If Yes elaborate

About dryness and flaking

79. How long have you suffered this skin condition?
80. Describe what areas of your face are affected
81. What else can you tell me about your skin condition (ie: when I smoke it gets worse)?
82. Have you had any particular treatments to treat your skin condition? If Yes elaborate

About excessive oiliness

83. How long have you suffered this skin condition?
84. Describe what areas of your face are affected
85. What else can you tell me about your skin condition (ie: when I smoke it gets worse)?
86. Have you had any particular treatments to treat your skin condition? If Yes elaborate

About skin flusing/going red easily

87. How long have you suffered this skin condition?
88. Describe what areas of your face are affected
89. What else can you tell me about your skin condition (ie: when I smoke it gets worse)?
90. Have you had any particular treatments to treat your skin condition? If Yes elaborate