Skin Type Questionnaire

My skin is ______________ sensitive: *

Somewhat

Extremely

Not

My main skin concern is: *

Dryness

Sensitivity or sensitivity and dryness

Oiliness, prone to congestion

Oily T-Zone (forehead, nose and chin)

I can’t complain

By midday my skin: *

Feels drier – may have some slight peeling appearing

May have some slight peeling and some redness

Looks fresh and clean

Has a tendency to look shiny in the T-Zone

Has a tendency to look overall shiny

When I am stressed or tired my skin has a tendency to look: *

Matte, dull and lifeless

Reddish and flushed

Puffy, ie. water retention

Overall, I would say my skin is: *

On the dry side, thin

Of medium thickness, tends to be sensitive and may sunburn easily

Oily, smooth, thick

I have broken, red capillaries or rosacea: *

Yes

No

Presently, I have _________________blemishes (pimples, acne): *

no

A few here and there

Many

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