Client Skin Analysis - Terri Lawton (Page 2 of 4) in pdf

Client Skin Analysis - Terri Lawton Page 2

6. Do you have skin pigmentation issues? (i.e.: skin discoloration, light and

dark patches) Yes____ No____

If yes, when did the pigmentation onset? ________________________________

If yes, how old were you? _________________

If yes, did your pigmentation issues coincide with any of the following?

___ Extreme sun exposure

___ Pregnancy

___ Use of birth control pills

___ Use of antibiotics or other medications

Other ______________________________

Has your pigmentation recently changed? Yes ____ No ____

If yes, when did you notice the change?

___ Within the past (1-3) months

___ Within the past (3-6) months

___ Within the past year

Other ______________________

7. Does your skin breakout? Yes____ No____

If yes, how often?

___ Frequently (Weekly)

___ About once a month

___ Infrequently, (a few times per year)

___ When I was younger

___ Only recently

If yes, where do you breakout?

___ Chin/jaw

___ Forehead

___ Cheeks

___ Nose

___ Neck/back

Other ____________________

Client Skin Analysis - Terri Lawton Page 2