1. What is your skin type? Normal Dry Oily Combination

2. Do you experience predictable acne flares prior to your period?
Yes     No

3. Are you over 35 but still breaking out with pimples?
Yes     No

4. Has you skin changed with the onset of menopause?
Yes     No

5. Do you have dark blotches on your cheeks and forehead?
Yes     No

6. Do you or other people notice sudden changes in your skin or hair when you are undergoing big changes (good or bad) in your life?
Yes     No

7. Have you experienced acne, itchy rashes, hives or other skin eruptions that seems to come and go depending on your level of stress?
Yes     No

8. Do you have a tendency to rub, pick or scratch your face while reading, studying or thinking about a problem?
Yes     No

9. Does your skin tend to break out or develop problems during allergy season or when you use products such as cologne, nail polish and hair spray?
Yes     No

10. Is it difficult for you to find skin care products that don't irritate or upset your skin?
Yes     No

11. Does your skin react to certain foods that you eat?
Yes     No

12. Do insects seem to love your skin, and once you've been bitten, do you find it very itchy and painful?
Yes     No

13. Did you or do you spend a lot of time outdoors engaging in activities such as gardening, sailing and swimming?
Yes     No

14. Are you or were you in an outdoor occupation?
Yes     No

15. Do you have light colored skin, blue eyes, red or blonde hair?
Yes     No

16. Do you have brown spots, irregular areas of color on your skin or freckles?
Yes     No

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