Is the condition of your skin the best that it can be? How can you make it healthier? What products are best suited to your skin type? How can you protect your skin from sun exposure, dryness and premature aging? The SPA LAB skin analysis, free to all visitors, can help you answer these questions and arrive at a customized daily skin care routine perfect for you.
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Instructions:Please read and answer each question carefully. Bring in your printed and competed form and we will be able to address your personal skincare issues. The information you provide is strictly confidential and will be used only for the purpose of skin analysis. PLEASE NOTE: Unless otherwise noted, all questions must be completed.
Full Name: E-mail:
Your Age is:
under 19 19-25 26-35 36-45 46-59 60+
Your Sex is:
Female Male
1. Which of the following most closely describes your skin tone:
Very Fair, burns easily, never tans, freckles (typically red hair)
Light, burns first, then tans (typically blond hair)
Light Olive, sometimes burns (typically light to medium brown hair)
Medium Olive, rarely burns (typically Asian or Hispanic)
Dark Brown, never burns (typically African-American)
2. Which of the following best describes you skin type:
Very Oily Skin, large pores
Oily Skin
Combination Skin, oily in the T-zone, dry/normal cheeks
Normal Skin
Dry Skin, small pores
3. Does your skin break out?
Almost Always Frequently Rarely Never
4. How would you describe your skin?
Sensitive Resilient Not Sure
5. Do you have small, red, broken blood vessels on your face?
Yes No
6. Do you spent a lot of time outdoors?
Yes No
7. Do you wear sunscreen?
Always Sometimes Never
8. Do you go to tanning booths?
Frequently Sometimes Never
9. Do you have any "age spots" or sun damage on your face?
Yes No
10. Do you smoke?
Yes No
11. Are you currently using Retin-A or Renova?
Yes No
12. If so, how long have you been using it?
under 3 months 3 months-1 year 1-3 years over 3 years
13. Do you experience any irritation, dryness or flakiness from Retin-A?
Yes No
14. Are you currently using the drug Accutane?
Yes No
15. Have you undergone laser skin resurfacing in the last 3 months?
Yes No
16. Do you have allergies to any of the following?
