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Laser - Advanced Skin Typing
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
What is your ethnicity?
Your answer
Parents and grandparent ethnicity?
Your answer
Natural Hair Colour
*
0-Red 1-Blond 2-Chestnut or dark blond 3-Brown or dark brown 4-Black
Red
0
1
2
3
4
Black
Eye Colour
*
0-Light Blue, grey or green 1-Blue, grey or green 2-Medium blue 3-Dark brown 4-Brown black
Light Blue, grey or green
0
1
2
3
4
Brown black
Natural Skin Colour
*
0-Pinkish 1-Very pale 2-Pale with beige tint 3-Light brown 4-Dark brown
Pinkish
0
1
2
3
4
Dark brown
Freckles
*
0-Many 1-Several 2-Few 3-Incidental 4-None
Many
0
1
2
3
4
None
What happens when you are in the sun too long?
*
0-Red painful blister peel 1-Burns then peels 2-Burns sometimes followed by peeling 3-Rare burns 4-Never had a burn
Red painful blister peel
0
1
2
3
4
Never had a burn
Tan
*
0-Hardly 1-Light tan 2-Reasonable tan 3-Tan very easy 4-Turn dark brown
Hardly
0
1
2
3
4
Turn dark brown
How does your face do in the sun?
*
0-Very sensitive 1-Sensitive 2-Normal 3-Resistant 4-Never had a problem
Very sensitive
0
1
2
3
4
Never had a problem
Sun exposure and tanning beds or creams
*
0-More than 3 mths ago 1- 2-3 mths ago 2- 1-2 mths ago 3- Less than 1 mth 4- Within 2 weeks
More than 3 mths ago
0
1
2
3
4
Within 2 weeks
Do you expose the areas you want treated to the sun?
*
0-Never 1-Hardly 2-Sometimes 3-Often 4-Always
Never
0
1
2
3
4
Always
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