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Skin Assessment
What is your name?
How old are you?
What is your gender?
Male
Female
Rather not say
Which statement best describes your skin?
Very fair skin & burns instantly in the sun Fair skin, burns easily & tans poorly
Medium white to olive skin, sometimes burns but usually tans
Olive/brown skin, rarely burns & always tans
Brown skin, never burns & always tans Black skin, never burns & always tans
Tell us about your skin concerns (select all that apply to you)
Oiliness
Dryness
Dehydration
Dullness
Rough skin
Uneven skin tone
Large pores
Dark eye circles
Loss of firmness
Lines & wrinkles
Crepey skin
Sensitivity
Acne
Breakouts
Acne Scarring
Rosacea
Redness
Sun damage
Hyperpigmentation
Other scars
Other
Describe your current daily skincare routine, including any skincare brands you are using.
What are your top 3 skin concerns?
How much do you spend on skincare products?
How much do you spend on skincare products?
I don’t mind, quality is more important than price
I prefer to use mid-priced products
I prefer to use low-priced products
Is there anything else worth noting? Any skin conditions we haven’t mentioned, any medical history or medication, or if appliable, are you pregnant?
Do you have any allergies?
Would you like to upload a photo? (optional) Make up free, natural light, close up
By uploading a close-up picture of your face your aesthetic doctor can examine your skin and offer more appropriate product recommendations. If you do not wish to upload a picture, please ignore this question.
When is best to contact you?
Preferred time of day
Morning
Afternoon
Evening
Please send me information about your services and offers
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Dr Saba Raja
Clinician | NHS GP
Hi
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