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New - Client Skin Analysis
Name:
*
Please fill out this field.
Date:
*
August 2026
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Age:
*
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Sex:
*
required
Male
Female
Address:
*
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City:
*
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State:
*
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Zip:
*
Please enter a number.
Known Allergies:
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Current Medications:
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Skin Classification (Fitzpatrick):
*
required
Type I-Very Pale/Never tans/Always burns
Type II-Pale/Rarely Tans/Burns Easily
Type III-Light/Light Tan/Sometimes Burns
Type IV-Olive/Rarely Burns/Can Tan
Type V-Brown/Rarely Burns/Tans Well
Type VI-Dark/Never Burns/Tans Very Well
Select all applicable skin conditions:
*
required
Normal
Dry
Dehydrated
Mature
Thin/Sensitive skin
Oily
Open pores
Blackheads
Whiteheads
Asphyxiated pores/follicles
Blemishes/Acne
Scars (from acne/etc)
Photoaging
Wrinkles
Superficial lines
Deep lines
Relaxed elasticity
Good elasticity
Any broken capillaries?
Dilated capillaries
Discolorations
Other
If other, please explain:
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If acne, how many years?:
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What classification(s) of acne?:
*
required
Vulgaris
Chronic
Cystic
Rosacea
Other
Not Applicable