Health History Form
Please fill out this to the best of your ability
Please choose whether you've had any of the following
What is the natural color of your hair?
What is the color of sun unexposed skin areas?
How many freckles on unexposed skin areas?
What happens when you are in the sun TOO long without sunblock?
Painful redness, blistering, peeling
Blistering followed by peeling
Burns, sometimes followed by peeling
How well do you turn brown?
Do you turn brown within one day of sun exposure?
How does your face respond to the sun?
When did you last expose yourself to the sun or artificial sun treatments?
Do you expose the area to be treated to the sun?
00-07 points = Skin type I
08-16 points = Skin type II
17-25 points = Skin type III
25-30 points = Skin type IV
30-40 points = Skin type V & VI
Thanks for submitting! We now have all health information needed to see you.