Get Confidential Skin Health Questionnaire

The Confidential Skin Health Questionnaire is a vital tool for assessing your skin health and personal medical history. This guide will help you navigate the form online, ensuring all necessary sections are completed accurately and effectively.

Follow the steps to fill out the Confidential Skin Health Questionnaire online.

1. Click ‘Get Form’ button to obtain the questionnaire and open it in your preferred editor.
2. Begin with the patient or client information section. Enter the date, your name, email address, and physical address, including city, state, and zip code. Additionally, provide your home, work, and cell phone numbers.
3. Proceed to the medical information section. Fill in your date of birth, age, and the name of your family physician. Indicate your smoking status, frequency of smoking, and whether you live with a smoker. Circle any past treatments or conditions that apply to you.
4. List any allergies or allergic reactions to products, as well as any medications you are currently taking. Indicate whether you are pregnant, trying to get pregnant, or undergoing hormone therapy, and note if you experience cold sores.
5. In the personal information section, rate your current and normal stress levels on a scale of 1 to 10. Mention your exercise habits, the date of your last sunburn, and provide information on your tanning bed usage.
6. Answer lingering questions about your treatments or history with dermatologists and estheticians. Specify the skin and makeup products you currently use and whether you apply environmental protection cream regularly.
7. Assess the overall quality of your skin on a scale of 1 to 10 and select your skin type by circling only one option that best represents your skin.
8. Complete the wish list section by indicating improvements you would like to see in your skin within the next 30 days. Mark preferences such as reduction of fine lines, sun damage, or acne scars.
9. Once all sections are filled out, review your information for accuracy. You have the option to save your changes, download, print, or share the form as needed.

Start completing your Confidential Skin Health Questionnaire online today to take the first step toward optimal skin health.