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What is the general appearance of your skin?

Dry Dry
Oily Oily
Normal Normal
Combination Combination

What is your Skin Concern?

Acne and Dark spots
Fine lines and Anti-aging
Under eye circles and Puffiness
Redness and Sensitive skin
Dryness and Dullness

Do you experience frequent breakouts?

Yes
No

Where do you notice the most wrinkles on your face?

Around the Eyes
Forehead
Around the mouth
All of the above

Do your under eyes appear noticeably darker than the rest of your face?

Yes
No

How does your skin typically react?

Becomes easily red or flushed
Feels irritated or itchy
Reacts poorly to sun exposure
None of the above

Do you experience tightness & lack of glow in your skin?

Yes
No

How does your current skin tone compare to your natural skin tone?

Lighter than usual
Same as usual
Darker than usual
Uneven

Do you experience both noticeable pores and frequent oiliness on your face?

Yes
No

How would you describe the appearance of your lips?

No visible cracks only darkening
Very faint darkening and cracks
Noticeable darkening with cracks
Prominent darkening and cracks

Does your skin become rougher after spending time outdoors without sun protection?

Yes
No

Do you have prolonged exposure to sun?

Yes
No

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