Skin Analysis Questionnaire Name * Enter Email * Phone * Image * Choose FileNo file chosenDelete uploaded file 1. Skin Characteristics 1. How would you describe your skin type? *OilyDryCombinationNormalSensitive 2.Do you experience any of the following? (check all that apply) *Acne or breakoutsBlackheads/whiteheadsRedness or irritationFlakinessLarge poresExcess shineFine lines or wrinklesHyperpigmentation or dark spots 3. How often does your skin feel tight, itchy, or uncomfortable? *NeverSometimesOftenEvery day 4. How would you describe your skin’s sensitivity level? *Not sensitiveMildly sensitiveReactive to some productsVery sensitive (easily irritated) 2. Lifestyle Questions 1. How many hours of sleep do you get per night? *<55–67–88+ 2. How often do you experience stress? *RarelySometimesOftenConstantly 3. Do you smoke or vape? *NoYes, occasionallyDaily 4. How much water do you drink daily? *<1 L1–1.5 L2–3 L3+ L 3. Diet Questions 1. How often do you consume: Fruits & vegetables *RarelySometimesDaily Fast food or fried foods *RarelyWeeklySeveral times a week Sugary foods/drinks: *RarelyWeeklyDaily Dairy products: *RarelyModerateDaily High-glycemic foods (white bread, sweets, pasta): *RarelyWeeklyDaily If yes, list them: *2. Do you have any known food sensitivities? 3. Do you drink alcohol? *NoOccasionallyWeeklyDaily 4. Skincare Routine 2. How many steps is your current skincare routine? *I don’t have a routine1–2 steps3–4 steps5+ steps 3. Which products do you use regularly? *CleanserTonerMoisturiserSunscreenExfoliant (chemical or physical)Retinol/retinoidsVitamin CAcne treatments (benzoyl peroxide, salicylic acid, etc.)Facial oilsMasks 4. How often do you wear sunscreen with SPF 30+? *NeverOnly outdoorsMost daysEvery day 5. Do you remove makeup before sleeping? *YesNoI don’t wear makeup If yes, list them: *6. Any products your skin reacted badly to? 5. Age and skin needs 1. what age group do you fall under? ? *below 1819-2526-3536-45above 46 Request Analysis