Section 1 - Your Genetic Disposition:Choose one selection to answer each question below.
What is your natural eye color?
What is your natural eye color?
Light Blue, Green or Grey
Medium Blue, Green or Grey
Light Brown
Dark Brown
Brownish / Black
What is your natural hair color?
What is your natural hair color?
Light Blonde or Red
Medium Blonde
Chesnut/Medium Brown
Dark Brown
Black
What color are areas of your skin that have never seen the sun?
What color are areas of your skin that have never seen the sun?
Reddish
Very Pale
Pale with Beige Tint
Light Brown
Dark Brown
How many freckles do you have?
How many freckles do you have?
Many
Several
Few
Incidental
None
Section 2 - Sun Exposure:Choose one selection to answer each question below.
What happens if you stay in sun too long?
What happens if you stay in sun too long?
Painful, redness, blistering, peeling
Blistering followed by peeling
Burns sometimes , followed by peeling
Rarely burns
Never burns
To what degree do you turn brown?
To what degree do you turn brown?
Hardly or not at all
Light tan
Reasonable Tan
Tan Easily
Turn Dark Brown Easily
Do you turn brown several hours after exposure to sun?
Do you turn brown several hours after exposure to sun?
Never
Seldom
Sometimes
Often
Always
How does your face react to sun?
How does your face react to sun?
Very Sensitive
Sensitive
Normal
Very Resistant
Never had a problem
Section 3 - Tanning Habits:Choose one selection to answer each question below.
When did you last expose the area to be treated to sun or tanning booth?
When did you last expose the area to be treated to sun or tanning booth?
More than 3 months ago
2-3 months ago
1-2 months ago
Less than 1 month ago
Less than 2 weeks ago
How often do you expose the area to being treated to sun or tanning booths?
How often do you expose the area to being treated to sun or tanning booths?
Never
Hardly Ever
Sometimes
Often
Always
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