Skin Revision Skin Care Assessment Form
Skin Revision Skin Care Assessment Form
Kindly fill out the required details below to ensure a comprehensive and personalized skin care assessment.
Client Information
Name
Phone number
Address
Medical History
Do you have any known allergies?
Are you currently taking any medications?
Do you have a history of the following
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Acne
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Rosacea
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Psoriasis
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Eczema
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Hyperpigmentation
Are you currently pregnant or breastfeeding?
What are your primary skin concerns?
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Fine lines/wrinkles
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Uneven skin tone
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Dryness
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Oiliness
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Acne
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Sensitivity
What is your skin type?
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Normal
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Dry
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Oily
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Combination
Consent and Acknowledgment
By signing below, I confirm that the information provided above is accurate to the best of my knowledge. I understand that this form will be used to create a personalized skin care plan and agree to adhere to the recommendations provided by the skincare professional.
Date:
Assessment Forms @ Template.net
