Skin Care Survey

Please circle your response for your skin type

Is your skin? Oily Dry Combination
What is your main skin concerns? Acne/breakout prone skin with dark marks or uneven skin tone Acne/breakout prone skin/or ingrown hairs Dark marks, uneven skin tone, and/or sun damage
What is your main skin concerns? Large pores or pitted acne scars Anti-aging and fine lines Dark under eye circles
Do you have sensitive skin? Yes No Additional comment
Do you have chronic facial redness? Yes No Additional comment
Do your skin? Lack tone Lack glow
Are you not please with your skin tone? Yes No Why not if no?
Is your skin causing health issues Yes No Comment
If we are experiencing health concerns in relation to our skin cares or types, we should check with our Spiritual Physician (SP) and Medical Physician (MP) who will then collectively refer us to Dermatologist.
This Skin Care survey is just a survey to be considered as a tool to assist us with our skin care health. Remember these words of encouragement: “I pray that I may enjoy good health and that all may go well with me, even as my soul is getting along well” 3 John 2.
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