Fitzpatrick Skin Type Quiz Template

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Fitzpatrick Skin Type Quiz
This information will help our office to better evaluate your skin type so the laser treatment will be more
effective. Skin type is often categorized according to the Fitzpatrick skin type scale which ranges from very
fair (skin type I) to very dark (skin type VI). The two main factors that influence skin type and the treatment
program devised by your practitioner are:
Genetic Disposition
Reaction to sun exposure and tanning beds
Skin type is determined genetically and is one of the many aspects of your overall appearance, which also
includes the color of your eyes, hair, etc. The way your skin responds to sun exposure is another way of
correctly assessing your skin type. Recent tanning, whether by the sun or an artificial tanning booth, even
tanning creams, can have a major impact on your skin color evaluation.
By using the information you provide on this form, we can be better prepared to provide you with the best
care. Please take a few minutes to fill out this questionnaire.
Mark 0 through 4 for each question
Genetic Disposition
0
1
2
3
4
Color of eyes
Light blue,
Blue, gray or
Brownish
gray, green
green
Blue
Dark Brown
black
Natural hair
Chestnut,
color
Sandy red
Blonde
dark blonde
Dark brown
Black
Skin color
(non exposed
Reddish
Very pale
Pale with
Light brown
Dark Brown
areas
beige tint
Freckles on
exposed areas
Many
Several
Few
Incidental
None
Reaction to sun Exposure
0
1
2
3
4
Painful
Burns
If too long in
Redness
Blistering
sometimes
the sun
Blistering
followed by
followed by
Rare burns
Never had
Peeling
peeling
peeling
burn
Degree of
Turns dark
skin turning
Hardly
Light color
Reasonable
Tans easily
brown
brown
Not at all
tan
tan
quickly
Turns brown
within several
hours after
Never
Seldom
Sometimes
Often
Always
sun exposure
Face reaction
Never a

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