Please answer the following questions by circling the number which best describes you. Your clinician will total your score during the consultation.
If your score is:
your skin type is:
0 – 3
4 – 7
8 – 11
12 – 15
16 – 19
20 – 24
Additional skin response questions:
I have answered the questions contained in this questionnaire to the best of my knowledge. I understand that it is my responsibility to inform my practitioner of my current health conditions while seeking treatment as a patient. I will update this information as it occurs.
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