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	<title>Quizzes &amp; Surveys Archive - Beauty Spot Aesthetic</title>
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		<title>Online Consultation</title>
		<link>https://beauty-spot.co.za/qsm_quiz/online-consultation/</link>
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		<pubDate>Wed, 06 May 2020 14:16:48 +0000</pubDate>
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					<description><![CDATA[<p>The post <a href="https://beauty-spot.co.za/qsm_quiz/online-consultation/">Online Consultation</a> appeared first on <a href="https://beauty-spot.co.za">Beauty Spot Aesthetic</a>.</p>
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		<p><h4><strong>OILY VS DRY<br /><br /></strong><strong><em>This section determines the skin oil production and hydration</em>:</strong></h4><br /> <br /><br />1.  Would you characterise your facial skin as:</p>
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		<p>2.  Do you have enlarge pores?</p>
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					A few in the T-zone (forehead and nose)					</label>
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					Tons					</label>
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		<p>3.  You have clogged pores (blackheads or whiteheads)</p>
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					Always					</label>
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		<p>4.  How Old do you think your skin look?</p>
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					More than 5 years older than your age					</label>
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		<p>5.  In Photos, your face appears shiny</p>
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					Frequently					</label>
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					Always					</label>
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		<p>6.  When you use soap or cleansers that bubbles and Foams, your facial skin feels?</p>
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					Feels dry or cracked					</label>
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					Feels slightly dry but does not crack					</label>
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					Feels Normal					</label>
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					I dont know as i dont use soap or foaming cleanser					</label>
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					 			<label style="display: none !important;" for="question6_none">None</label>
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		<p>7.  Two or Three Hours after applying moisturiser your cheeks feel</p>
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					Very Roug, flakey or ashy					</label>
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					Slightly Shiny					</label>
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					Shiny and sticky or i dont use moisturizer					</label>
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					 			<label style="display: none !important;" for="question9_none">None</label>
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		<p>8.  Your Face is OIly in the T-Zone(forehad and nose)</p>
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					Never					</label>
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					Frequently					</label>
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					Sometimes					</label>
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											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question8" id="question8_4" value="3" />
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					Always					</label>
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					 			<label style="display: none !important;" for="question8_none">None</label>
			<input type="radio" style="display: none;" name="question8" id="question8_none" checked="checked" value="" />
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		<p>9.  What is your Current Skin Routine?</p>
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							Cleanse						</label>
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										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,6) name="question35[]" id="question35_2" value="1" />
						<label class="qsm-input-label" for="question35_2">
							Tone						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,6) name="question35[]" id="question35_3" value="2" />
						<label class="qsm-input-label" for="question35_3">
							Eye treatment						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,6) name="question35[]" id="question35_4" value="3" />
						<label class="qsm-input-label" for="question35_4">
							Serum						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,6) name="question35[]" id="question35_5" value="4" />
						<label class="qsm-input-label" for="question35_5">
							Moisturizer						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,6) name="question35[]" id="question35_6" value="5" />
						<label class="qsm-input-label" for="question35_6">
							Sunblock						</label>
					</div>
						</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_35" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment35" name="mlwComment35" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
									</section>
								<section class="qsm-page qsm-question-page  qsm-page-1"
						data-pid="1" data-qpid="2" data-prevbtn="0" style='display: none;'>
														<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-10 ' data-qid='10'>
						<div class='mlw_qmn_question ' >
		<p><h4>Inflammation vs Resistance<br /><br /><strong><em>This section assesses your skin tendency to develop pimples, redness, flushing and itching. All signs of inflammatory skin conditions.</em></strong></h4><br /> <br /><br />10.  You get red bumps or pimples on your face:</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question10-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question10" id="question10_1" value="0" />
					<label class="qsm-input-label" for="question10_1">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question10-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question10" id="question10_2" value="1" />
					<label class="qsm-input-label" for="question10_2">
					At least once a month					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question10-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question10" id="question10_3" value="2" />
					<label class="qsm-input-label" for="question10_3">
					Rarely					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question10-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question10" id="question10_4" value="3" />
					<label class="qsm-input-label" for="question10_4">
					At least one a week					</label>
					 				</div>
					 			<label style="display: none !important;" for="question10_none">None</label>
			<input type="radio" style="display: none;" name="question10" id="question10_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_10" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment10" name="mlwComment10" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-11 ' data-qid='11'>
						<div class='mlw_qmn_question ' >
		<p>11.  How Often do you tend to get red and flushed after drinking alcohol  and or eating spicy food:</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question11-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question11" id="question11_1" value="0" />
					<label class="qsm-input-label" for="question11_1">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question11-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question11" id="question11_2" value="1" />
					<label class="qsm-input-label" for="question11_2">
					Sometimes					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question11-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question11" id="question11_3" value="2" />
					<label class="qsm-input-label" for="question11_3">
					Freqeuntly					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question11-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question11" id="question11_4" value="3" />
					<label class="qsm-input-label" for="question11_4">
					Always					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question11-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question11" id="question11_5" value="4" />
					<label class="qsm-input-label" for="question11_5">
					I dont know because i never drink alcohol or eat spicey food					</label>
					 				</div>
					 			<label style="display: none !important;" for="question11_none">None</label>
			<input type="radio" style="display: none;" name="question11" id="question11_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_11" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment11" name="mlwComment11" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-12 ' data-qid='12'>
						<div class='mlw_qmn_question ' >
		<p>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</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question12-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question12" id="question12_1" value="0" />
					<label class="qsm-input-label" for="question12_1">
					None					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question12-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question12" id="question12_2" value="1" />
					<label class="qsm-input-label" for="question12_2">
					Some					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question12-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question12" id="question12_3" value="2" />
					<label class="qsm-input-label" for="question12_3">
					Few					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question12-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question12" id="question12_4" value="3" />
					<label class="qsm-input-label" for="question12_4">
					Many					</label>
					 				</div>
					 			<label style="display: none !important;" for="question12_none">None</label>
			<input type="radio" style="display: none;" name="question12" id="question12_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_12" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment12" name="mlwComment12" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-13 ' data-qid='13'>
						<div class='mlw_qmn_question ' >
		<p>13.  SkinCare Products (including cleanser, moisturisers, toners and make up) cause your skin to break out, get a rash, itch or sting.</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question13-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question13" id="question13_1" value="0" />
					<label class="qsm-input-label" for="question13_1">
					They never do					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question13-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question13" id="question13_2" value="1" />
					<label class="qsm-input-label" for="question13_2">
					They often do					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question13-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question13" id="question13_3" value="2" />
					<label class="qsm-input-label" for="question13_3">
					I dont wear products on my face					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question13-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question13" id="question13_4" value="3" />
					<label class="qsm-input-label" for="question13_4">
					They rarely do					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question13-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question13" id="question13_5" value="4" />
					<label class="qsm-input-label" for="question13_5">
					They always do					</label>
					 				</div>
					 			<label style="display: none !important;" for="question13_none">None</label>
			<input type="radio" style="display: none;" name="question13" id="question13_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_13" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment13" name="mlwComment13" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-14 ' data-qid='14'>
						<div class='mlw_qmn_question ' >
		<p>14.  Have you ever been diagnosed with acne, rosacea, dermatitis or eczema?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question14-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question14" id="question14_1" value="0" />
					<label class="qsm-input-label" for="question14_1">
					No					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question14-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question14" id="question14_2" value="1" />
					<label class="qsm-input-label" for="question14_2">
					No, but people tell me i looks like i have it					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question14-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question14" id="question14_3" value="2" />
					<label class="qsm-input-label" for="question14_3">
					Yes					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question14-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question14" id="question14_4" value="3" />
					<label class="qsm-input-label" for="question14_4">
					Yes a severe case					</label>
					 				</div>
					 			<label style="display: none !important;" for="question14_none">None</label>
			<input type="radio" style="display: none;" name="question14" id="question14_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_14" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment14" name="mlwComment14" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-15 ' data-qid='15'>
						<div class='mlw_qmn_question ' >
		<p>15.  If you wear jewellery that is not 14-carat gold or silver, how often do you get a rash?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question15-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question15" id="question15_1" value="0" />
					<label class="qsm-input-label" for="question15_1">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question15-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question15" id="question15_2" value="1" />
					<label class="qsm-input-label" for="question15_2">
					Rarely					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question15-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question15" id="question15_3" value="2" />
					<label class="qsm-input-label" for="question15_3">
					Often					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question15-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question15" id="question15_4" value="3" />
					<label class="qsm-input-label" for="question15_4">
					Not Sure					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question15-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question15" id="question15_5" value="4" />
					<label class="qsm-input-label" for="question15_5">
					Always					</label>
					 				</div>
					 			<label style="display: none !important;" for="question15_none">None</label>
			<input type="radio" style="display: none;" name="question15" id="question15_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_15" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment15" name="mlwComment15" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-16 ' data-qid='16'>
						<div class='mlw_qmn_question ' >
		<p>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?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question16-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question16" id="question16_1" value="0" />
					<label class="qsm-input-label" for="question16_1">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question16-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question16" id="question16_2" value="1" />
					<label class="qsm-input-label" for="question16_2">
					Frequently					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question16-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question16" id="question16_3" value="2" />
					<label class="qsm-input-label" for="question16_3">
					Sometimes					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question16-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question16" id="question16_4" value="3" />
					<label class="qsm-input-label" for="question16_4">
					Always					</label>
					 				</div>
					 			<label style="display: none !important;" for="question16_none">None</label>
			<input type="radio" style="display: none;" name="question16" id="question16_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_16" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment16" name="mlwComment16" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
									</section>
								<section class="qsm-page qsm-question-page  qsm-page-2"
						data-pid="2" data-qpid="3" data-prevbtn="0" style='display: none;'>
														<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-17 ' data-qid='17'>
						<div class='mlw_qmn_question ' >
		<p><h4>PIGMENTED vs NON-PIGMENTED<br /><br /><em>This section assesses your skin tendency to form melanin, a skin pigment that produce darker skin tones, dark patches, freckles and dark areas after trauma.</em></h4><br /> <br /><br />17.  After you have a pimple or ingrown hair, its followed by a dark brownish/black spot.</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question17-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question17" id="question17_1" value="0" />
					<label class="qsm-input-label" for="question17_1">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question17-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question17" id="question17_2" value="1" />
					<label class="qsm-input-label" for="question17_2">
					Frequently					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question17-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question17" id="question17_3" value="2" />
					<label class="qsm-input-label" for="question17_3">
					I never get pimples or ingrown hair					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question17-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question17" id="question17_4" value="3" />
					<label class="qsm-input-label" for="question17_4">
					Sometimes					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question17-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question17" id="question17_5" value="4" />
					<label class="qsm-input-label" for="question17_5">
					Always					</label>
					 				</div>
					 			<label style="display: none !important;" for="question17_none">None</label>
			<input type="radio" style="display: none;" name="question17" id="question17_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_17" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment17" name="mlwComment17" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-19 ' data-qid='19'>
						<div class='mlw_qmn_question ' >
		<p>18.  Do you have small browns spots (freckles or sun spots) on your face, chest, back or arms?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question19-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question19" id="question19_1" value="0" />
					<label class="qsm-input-label" for="question19_1">
					No					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question19-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question19" id="question19_2" value="1" />
					<label class="qsm-input-label" for="question19_2">
					Yes Many (6-15)					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question19-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question19" id="question19_3" value="2" />
					<label class="qsm-input-label" for="question19_3">
					Yes, a few (1-5)					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question19-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question19" id="question19_4" value="3" />
					<label class="qsm-input-label" for="question19_4">
					Yes, tons 16 or more					</label>
					 				</div>
					 			<label style="display: none !important;" for="question19_none">None</label>
			<input type="radio" style="display: none;" name="question19" id="question19_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_19" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment19" name="mlwComment19" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-18 ' data-qid='18'>
						<div class='mlw_qmn_question ' >
		<p>19.  Have you been diagnosed with melasma, light or dark brown or grey patches on your face?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question18-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question18" id="question18_1" value="0" />
					<label class="qsm-input-label" for="question18_1">
					No					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question18-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question18" id="question18_2" value="1" />
					<label class="qsm-input-label" for="question18_2">
					Yes					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question18-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question18" id="question18_3" value="2" />
					<label class="qsm-input-label" for="question18_3">
					I'm not sure					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question18-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question18" id="question18_4" value="3" />
					<label class="qsm-input-label" for="question18_4">
					One, but it went away					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question18-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question18" id="question18_5" value="4" />
					<label class="qsm-input-label" for="question18_5">
					Yes , severe					</label>
					 				</div>
					 			<label style="display: none !important;" for="question18_none">None</label>
			<input type="radio" style="display: none;" name="question18" id="question18_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_18" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment18" name="mlwComment18" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-20 ' data-qid='20'>
						<div class='mlw_qmn_question ' >
		<p>20.  When exposed to sun for the first time in several months, your skin</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question20-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question20" id="question20_1" value="0" />
					<label class="qsm-input-label" for="question20_1">
					Burns only					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question20-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question20" id="question20_2" value="1" />
					<label class="qsm-input-label" for="question20_2">
					Burns then get darker					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question20-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question20" id="question20_3" value="2" />
					<label class="qsm-input-label" for="question20_3">
					Gets darker					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question20-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question20" id="question20_4" value="3" />
					<label class="qsm-input-label" for="question20_4">
					My skin is already dark, so it is hard to see if it get darker					</label>
					 				</div>
					 			<label style="display: none !important;" for="question20_none">None</label>
			<input type="radio" style="display: none;" name="question20" id="question20_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_20" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment20" name="mlwComment20" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-25 ' data-qid='25'>
						<div class='mlw_qmn_question ' >
		<p>21.  Over your entire life, how many cigarettes have you smoked (or been exposed to?)</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question25-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question25" id="question25_1" value="0" />
					<label class="qsm-input-label" for="question25_1">
					None					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question25-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question25" id="question25_2" value="1" />
					<label class="qsm-input-label" for="question25_2">
					a Few packs					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question25-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question25" id="question25_3" value="2" />
					<label class="qsm-input-label" for="question25_3">
					Several to many packs					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question25-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question25" id="question25_4" value="3" />
					<label class="qsm-input-label" for="question25_4">
					I smoke every day					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question25-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question25" id="question25_5" value="4" />
					<label class="qsm-input-label" for="question25_5">
					I've never Smoked but im around people who regulary smoked in my presence					</label>
					 				</div>
					 			<label style="display: none !important;" for="question25_none">None</label>
			<input type="radio" style="display: none;" name="question25" id="question25_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_25" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment25" name="mlwComment25" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-22 ' data-qid='22'>
						<div class='mlw_qmn_question ' >
		<p>22.  Do you have a history of melanoma (skin cancer) yourself or in your immediate family?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question22-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question22" id="question22_1" value="0" />
					<label class="qsm-input-label" for="question22_1">
					No					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question22-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question22" id="question22_2" value="1" />
					<label class="qsm-input-label" for="question22_2">
					1 Person in my family					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question22-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question22" id="question22_3" value="2" />
					<label class="qsm-input-label" for="question22_3">
					More than 1 in my family					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question22-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question22" id="question22_4" value="3" />
					<label class="qsm-input-label" for="question22_4">
					I have a history of Melanoma					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question22-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question22" id="question22_5" value="4" />
					<label class="qsm-input-label" for="question22_5">
					I'm not sure					</label>
					 				</div>
					 			<label style="display: none !important;" for="question22_none">None</label>
			<input type="radio" style="display: none;" name="question22" id="question22_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_22" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment22" name="mlwComment22" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-26 ' data-qid='26'>
						<div class='mlw_qmn_question ' >
		<p>23.  Please describe the air pollution where you reside:</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question26-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question26" id="question26_1" value="0" />
					<label class="qsm-input-label" for="question26_1">
					The air is fresh and clean					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question26-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question26" id="question26_2" value="1" />
					<label class="qsm-input-label" for="question26_2">
					For part of the year, but not all of the year, i reside in a place with clean air					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question26-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question26" id="question26_3" value="2" />
					<label class="qsm-input-label" for="question26_3">
					The air is slightly polluted					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question26-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question26" id="question26_4" value="3" />
					<label class="qsm-input-label" for="question26_4">
					The air is very polluted					</label>
					 				</div>
					 			<label style="display: none !important;" for="question26_none">None</label>
			<input type="radio" style="display: none;" name="question26" id="question26_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_26" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment26" name="mlwComment26" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-21 ' data-qid='21'>
						<div class='mlw_qmn_question ' >
		<p>24.  What happens after you have had many days of consecutive sun exposure?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question21-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question21" id="question21_1" value="0" />
					<label class="qsm-input-label" for="question21_1">
					I sunburn and blister, but my skin does not change colour					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question21-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question21" id="question21_2" value="1" />
					<label class="qsm-input-label" for="question21_2">
					My skin becomes slightly darker					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question21-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question21" id="question21_3" value="2" />
					<label class="qsm-input-label" for="question21_3">
					My skin becomes much darker					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question21-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question21" id="question21_4" value="3" />
					<label class="qsm-input-label" for="question21_4">
					My skin is already dark so it is hard to see if it gets darker					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question21-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question21" id="question21_5" value="4" />
					<label class="qsm-input-label" for="question21_5">
					I'm not sure					</label>
					 				</div>
					 			<label style="display: none !important;" for="question21_none">None</label>
			<input type="radio" style="display: none;" name="question21" id="question21_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_21" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment21" name="mlwComment21" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
									</section>
								<section class="qsm-page qsm-question-page  qsm-page-3"
						data-pid="3" data-qpid="4" data-prevbtn="0" style='display: none;'>
														<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-27 ' data-qid='27'>
						<div class='mlw_qmn_question ' >
		<p><h4>A Healthy Aging <br /><br /><em>This section assesses your risk for premature skin ageing</em>.</h4><br /> <br /><br />25.  Do you have facial wrinkles?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question27-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question27" id="question27_1" value="0" />
					<label class="qsm-input-label" for="question27_1">
					No, not evern with movement such as smiling, frowning, or lifting my eyebrows					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question27-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question27" id="question27_2" value="1" />
					<label class="qsm-input-label" for="question27_2">
					Only when i move, such as smiling, frowning or lifting my eyebrows					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question27-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question27" id="question27_3" value="2" />
					<label class="qsm-input-label" for="question27_3">
					Yes, with movement and a few at rest without movement					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question27-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question27" id="question27_4" value="3" />
					<label class="qsm-input-label" for="question27_4">
					Wrinkles are present even if im not smiling, frowning, or lifting my brows					</label>
					 				</div>
					 			<label style="display: none !important;" for="question27_none">None</label>
			<input type="radio" style="display: none;" name="question27" id="question27_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_27" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment27" name="mlwComment27" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-24 ' data-qid='24'>
						<div class='mlw_qmn_question ' >
		<p>26.  How often, if ever, have you been it to sun tanning bed?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question24-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question24" id="question24_1" value="0" />
					<label class="qsm-input-label" for="question24_1">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question24-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question24" id="question24_2" value="1" />
					<label class="qsm-input-label" for="question24_2">
					5-10 times					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question24-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question24" id="question24_3" value="2" />
					<label class="qsm-input-label" for="question24_3">
					1-5 times					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question24-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question24" id="question24_4" value="3" />
					<label class="qsm-input-label" for="question24_4">
					Many times					</label>
					 				</div>
					 			<label style="display: none !important;" for="question24_none">None</label>
			<input type="radio" style="display: none;" name="question24" id="question24_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_24" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment24" name="mlwComment24" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-28 ' data-qid='28'>
						<div class='mlw_qmn_question ' >
		<p>27.  How often do you wear sunscreen on your face? (Not the SPF in the make up)</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question28-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question28" id="question28_1" value="0" />
					<label class="qsm-input-label" for="question28_1">
					Everyday					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question28-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question28" id="question28_2" value="1" />
					<label class="qsm-input-label" for="question28_2">
					Sometimes, when i know I'm going to be in direct sunlight					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question28-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question28" id="question28_3" value="2" />
					<label class="qsm-input-label" for="question28_3">
					Rarely					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question28-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question28" id="question28_4" value="3" />
					<label class="qsm-input-label" for="question28_4">
					Never					</label>
					 				</div>
					 			<label style="display: none !important;" for="question28_none">None</label>
			<input type="radio" style="display: none;" name="question28" id="question28_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_28" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment28" name="mlwComment28" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-30 ' data-qid='30'>
						<div class='mlw_qmn_question ' >
		<p>28.  Please describe the lenght of time that you have used retinoid facial creams such as Retinol and Retin-A?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question30-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question30" id="question30_1" value="0" />
					<label class="qsm-input-label" for="question30_1">
					Many Years					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question30-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question30" id="question30_2" value="1" />
					<label class="qsm-input-label" for="question30_2">
					Occassionally					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question30-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question30" id="question30_3" value="2" />
					<label class="qsm-input-label" for="question30_3">
					Once for acne when i was younger					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question30-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question30" id="question30_4" value="3" />
					<label class="qsm-input-label" for="question30_4">
					Never					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question30-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question30" id="question30_5" value="4" />
					<label class="qsm-input-label" for="question30_5">
					I'm not sure what is retinol					</label>
					 				</div>
					 			<label style="display: none !important;" for="question30_none">None</label>
			<input type="radio" style="display: none;" name="question30" id="question30_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_30" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment30" name="mlwComment30" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-23 ' data-qid='23'>
						<div class='mlw_qmn_question ' >
		<p>29.  During the last five years, how often have you allowed your skin to tan intentionally or unintentionally through outdoor sport or other activities?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question23-1 ">
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					Never					</label>
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											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question23-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question23" id="question23_2" value="1" />
					<label class="qsm-input-label" for="question23_2">
					Once a week					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question23-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question23" id="question23_3" value="2" />
					<label class="qsm-input-label" for="question23_3">
					One a month					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question23-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question23" id="question23_4" value="3" />
					<label class="qsm-input-label" for="question23_4">
					Daily					</label>
					 				</div>
					 			<label style="display: none !important;" for="question23_none">None</label>
			<input type="radio" style="display: none;" name="question23" id="question23_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_23" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment23" name="mlwComment23" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-32 ' data-qid='32'>
						<div class='mlw_qmn_question ' >
		<p>30.  How Old are you?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers mlwRequiredRadio'>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question32-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question32" id="question32_1" value="0" />
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					Younger than 20					</label>
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					31-40					</label>
					 				</div>
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											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question32" id="question32_3" value="2" />
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					20-30					</label>
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											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question32" id="question32_4" value="3" />
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					41-65					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question32-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question32" id="question32_5" value="4" />
					<label class="qsm-input-label" for="question32_5">
					Over 65					</label>
					 				</div>
					 			<label style="display: none !important;" for="question32_none">None</label>
			<input type="radio" style="display: none;" name="question32" id="question32_none" checked="checked" value="" />
				</div>
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							</div>
									</section>
								<section class="qsm-page qsm-question-page  qsm-page-4"
						data-pid="4" data-qpid="5" data-prevbtn="0" style='display: none;'>
														<div class='quiz_section qsm-question-wrapper question-type-4 question-section-id-33 ' data-qid='33'>
						<div class='mlw_qmn_question ' >
		<p><h4>Your Medical History  <br /><br /><em>This section assesses the medical history information about you, and overall important to making the right choice in recommending the correct skin care products</em></h4><br /> <br />Please Tick if you have any of the following conditions and or on medications for these conditions.</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class="qmn_check_answers mlwRequiredRadio">
							<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_1" value="0" />
						<label class="qsm-input-label" for="question33_1">
							Diabetes						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_2" value="1" />
						<label class="qsm-input-label" for="question33_2">
							Psoriatis						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_3" value="2" />
						<label class="qsm-input-label" for="question33_3">
							Pacemaker						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_4" value="3" />
						<label class="qsm-input-label" for="question33_4">
							Metal pins or plates						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_5" value="4" />
						<label class="qsm-input-label" for="question33_5">
							Hormonal imbalances						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_6" value="5" />
						<label class="qsm-input-label" for="question33_6">
							Sinusitis / hayfever						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_7" value="6" />
						<label class="qsm-input-label" for="question33_7">
							Eczema						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_8" value="7" />
						<label class="qsm-input-label" for="question33_8">
							Menopause						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_9" value="8" />
						<label class="qsm-input-label" for="question33_9">
							Thyroid disorder						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_10" value="9" />
						<label class="qsm-input-label" for="question33_10">
							Hepatitis (fever blister)						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_11" value="10" />
						<label class="qsm-input-label" for="question33_11">
							Blood thinner medication						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_12" value="11" />
						<label class="qsm-input-label" for="question33_12">
							Acne medication (eg. Roaccutane)						</label>
					</div>
										<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input" onchange=qsmCheckMR(this,10) name="question33[]" id="question33_13" value="12" />
						<label class="qsm-input-label" for="question33_13">
							Pregnant						</label>
					</div>
						</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_33" value="" />
							<textarea class="qsm-question-comment qsm-question-comment-large mlw_qmn_question_comment" id="mlwComment33" name="mlwComment33" placeholder="Comments" onclick="qmnClearField(this)" ></textarea>
												</div>
											<div class='quiz_section qsm-question-wrapper question-type-0 question-section-id-37 ' data-qid='37'>
						<div class='mlw_qmn_question ' >
		<p>31. Which SkinCare Products are you interested in?</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class='qmn_radio_answers '>
								<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question37-1 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question37" id="question37_1" value="0" />
					<label class="qsm-input-label" for="question37_1">
					Bio Medical Emporium -Dr Judey Pretorius					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question37-2 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question37" id="question37_2" value="1" />
					<label class="qsm-input-label" for="question37_2">
					Diego Dalla Palma					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question37-3 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question37" id="question37_3" value="2" />
					<label class="qsm-input-label" for="question37_3">
					Wesson Therapeutics					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question37-4 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question37" id="question37_4" value="3" />
					<label class="qsm-input-label" for="question37_4">
					Mesoesthetics					</label>
					 				</div>
											<div class="qmn_mc_answer_wrap  mrq_checkbox_class" id="question37-5 ">
											<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name="question37" id="question37_5" value="4" />
					<label class="qsm-input-label" for="question37_5">
					Recommend the Best for my skin Condition					</label>
					 				</div>
					 			<label style="display: none !important;" for="question37_none">None</label>
			<input type="radio" style="display: none;" name="question37" id="question37_none" checked="checked" value="" />
				</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_37" value="" />
							</div>
									</section>
								<section class="qsm-page qsm-question-page  qsm-page-5"
						data-pid="5" data-qpid="6" data-prevbtn="0" style='display: none;'>
														<div class='quiz_section qsm-question-wrapper question-type-4 question-section-id-34 ' data-qid='34'>
						<div class='mlw_qmn_question ' >
		<p><h4>Terms and Conditions</h4><br /> 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 &amp; 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 &amp; 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</p>
	</div>
		<fieldset>
		<legend></legend>
	<div class="qmn_check_answers ">
							<div class="qsm_check_answer  mrq_checkbox_class">
						<input type="checkbox" class="qsm-multiple-response-input"  name="question34[]" id="question34_1" value="0" />
						<label class="qsm-input-label" for="question34_1">
							I agree and accept the terms and conditions						</label>
					</div>
						</div>
	</fieldset>
	<input type="hidden" name="answer_limit_keys_34" value="" />
							</div>
									</section>
							<section class="qsm-page" style="display: none;">
				<div class="quiz_section">
					<div class='qsm-after-message mlw_qmn_message_end'>
											</div>
										<div class="qsm_contact_div qsm-contact-type-text">
											<span class='mlw_qmn_question qsm_question'><label for="contact_field_0">Name</label></span>
								<input type='text' class='mlwRequiredText qsm_required_text '  name='contact_field_0' id='contact_field_0'  value=''  placeholder='Name'  />
									</div>
										<div class="qsm_contact_div qsm-contact-type-email">
											<span class='mlw_qmn_question qsm_question'><label for="contact_field_1">Email</label></span>
								<input type='email' class='mlwEmail mlwRequiredText qsm_required_text '  name='contact_field_1' id='contact_field_1'  value=''  placeholder='Email'  />
									</div>
										<div class="qsm_contact_div qsm-contact-type-text">
											<span class='mlw_qmn_question qsm_question'><label for="contact_field_2">Contact Number</label></span>
								<input type='text' class='mlwRequiredText qsm_required_text mlwPhoneNumber'  name='contact_field_2' id='contact_field_2'  value=''  onkeydown='return event.keyCode !== 69'  placeholder='Contact Number'  />
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<p>The post <a href="https://beauty-spot.co.za/qsm_quiz/online-consultation/">Online Consultation</a> appeared first on <a href="https://beauty-spot.co.za">Beauty Spot Aesthetic</a>.</p>
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