Free Online Skin Consultation Please complete the following sections to the best of your ability. Click NEXT to continue. OILY VS DRYThis section determines the skin oil production and hydration: 1. Would you characterise your facial skin as: Dry Combination Oily Normal None 2. Do you have enlarge pores? None A few in the T-zone (forehead and nose) Many Tons None 3. You have clogged pores (blackheads or whiteheads) Never Sometimes Rarely Always None 4. How Old do you think your skin look? 5-10 years younger than your age Your age 5 years older than your age More than 5 years older than your age None 5. In Photos, your face appears shiny Never, or you've never noticed a shine Sometimes Frequently Always None 6. When you use soap or cleansers that bubbles and Foams, your facial skin feels? Feels dry or cracked Feels slightly dry but does not crack Feels Normal I dont know as i dont use soap or foaming cleanser None 7. Two or Three Hours after applying moisturiser your cheeks feel Very Roug, flakey or ashy Smooth Slightly Shiny Shiny and sticky or i dont use moisturizer None 8. Your Face is OIly in the T-Zone(forehad and nose) Never Frequently Sometimes Always None 9. What is your Current Skin Routine? Cleanse Tone Eye treatment Serum Moisturizer Sunblock Inflammation vs ResistanceThis section assesses your skin tendency to develop pimples, redness, flushing and itching. All signs of inflammatory skin conditions. 10. You get red bumps or pimples on your face: Never At least once a month Rarely At least one a week None 11. How Often do you tend to get red and flushed after drinking alcohol and or eating spicy food: Never Sometimes Freqeuntly Always I dont know because i never drink alcohol or eat spicey food None 12. How many visible red or blue broken blood vessels (small veins) do yo have (or did you have prior to treatment) on your face or nose None Some Few Many None 13. SkinCare Products (including cleanser, moisturisers, toners and make up) cause your skin to break out, get a rash, itch or sting. They never do They often do I dont wear products on my face They rarely do They always do None 14. Have you ever been diagnosed with acne, rosacea, dermatitis or eczema? No No, but people tell me i looks like i have it Yes Yes a severe case None 15. If you wear jewellery that is not 14-carat gold or silver, how often do you get a rash? Never Rarely Often Not Sure Always None 16. How often does your face and or neck get red after moderate exercise, and or with stress or a strong emotion, such as anger? Never Frequently Sometimes Always None PIGMENTED vs NON-PIGMENTEDThis section assesses your skin tendency to form melanin, a skin pigment that produce darker skin tones, dark patches, freckles and dark areas after trauma. 17. After you have a pimple or ingrown hair, its followed by a dark brownish/black spot. Never Frequently I never get pimples or ingrown hair Sometimes Always None 18. Do you have small browns spots (freckles or sun spots) on your face, chest, back or arms? No Yes Many (6-15) Yes, a few (1-5) Yes, tons 16 or more None 19. Have you been diagnosed with melasma, light or dark brown or grey patches on your face? No Yes I'm not sure One, but it went away Yes , severe None 20. When exposed to sun for the first time in several months, your skin Burns only Burns then get darker Gets darker My skin is already dark, so it is hard to see if it get darker None 21. Over your entire life, how many cigarettes have you smoked (or been exposed to?) None a Few packs Several to many packs I smoke every day I've never Smoked but im around people who regulary smoked in my presence None 22. Do you have a history of melanoma (skin cancer) yourself or in your immediate family? No 1 Person in my family More than 1 in my family I have a history of Melanoma I'm not sure None 23. Please describe the air pollution where you reside: The air is fresh and clean For part of the year, but not all of the year, i reside in a place with clean air The air is slightly polluted The air is very polluted None 24. What happens after you have had many days of consecutive sun exposure? I sunburn and blister, but my skin does not change colour My skin becomes slightly darker My skin becomes much darker My skin is already dark so it is hard to see if it gets darker I'm not sure None A Healthy Aging This section assesses your risk for premature skin ageing. 25. Do you have facial wrinkles? No, not evern with movement such as smiling, frowning, or lifting my eyebrows Only when i move, such as smiling, frowning or lifting my eyebrows Yes, with movement and a few at rest without movement Wrinkles are present even if im not smiling, frowning, or lifting my brows None 26. How often, if ever, have you been it to sun tanning bed? Never 5-10 times 1-5 times Many times None 27. How often do you wear sunscreen on your face? (Not the SPF in the make up) Everyday Sometimes, when i know I'm going to be in direct sunlight Rarely Never None 28. Please describe the lenght of time that you have used retinoid facial creams such as Retinol and Retin-A? Many Years Occassionally Once for acne when i was younger Never I'm not sure what is retinol None 29. During the last five years, how often have you allowed your skin to tan intentionally or unintentionally through outdoor sport or other activities? Never Once a week One a month Daily None 30. How Old are you? Younger than 20 31-40 20-30 41-65 Over 65 None Your Medical History This section assesses the medical history information about you, and overall important to making the right choice in recommending the correct skin care products Please Tick if you have any of the following conditions and or on medications for these conditions. Diabetes Psoriatis Pacemaker Metal pins or plates Hormonal imbalances Sinusitis / hayfever Eczema Menopause Thyroid disorder Hepatitis (fever blister) Blood thinner medication Acne medication (eg. Roaccutane) Pregnant 31. Which SkinCare Products are you interested in? Bio Medical Emporium -Dr Judey Pretorius Diego Dalla Palma Wesson Therapeutics Mesoesthetics Recommend the Best for my skin Condition None Terms and Conditions The terms diagnosis is not a medical diagnosis and does not crate, replace , substitute, or change any medical diagnosis received from a medical practitioner. The term skin or dermal diagnosis refers to an online skin assessment based on the answers provided by yourself as a online customer. The accuracy of our online skin assessment depends solely on the answers provided by yourself when completing the online assessment. Beauty Spot Laser & Aesthetic will not be held liable if you do not agree with he results or outcome provided. The online skin assessment on the website www.beauty-spot.co.za does not replace proper consultation with a healthcare professional or Dermatologist. The term prescription is not to be construed as a written instruction by Beauty Spot Laser & Aesthetic , that authorises a patient to be issued with a medicine or treatment but. only amounts to a recommendation. A patient who has not consulted in person is not a patient but rather a online customer. A person who has consulted in person with a medical practitioner can in no way whatsoever be held to have received an actual written prescription. All uses of the products must be followed by the products instruction for application. No liability can be ascribed to medical practitioner where there was no physical one on one consultation I agree and accept the terms and conditions Name Email Contact Number Time's up
