|
0 |
1 |
2 |
3 |
4 |
What is the natural color of your eyes? |
Light Blue, Gray or Green |
Blue, Gray or Green |
Blue |
Dark Brown |
Brownish Black |
What is your natural hair color? (Prior to gray or white) |
Sandy Red |
Blonde |
Chestnut, Dark Blonde |
Dark Brown |
Black |
What is the color of your unexposed skin? (stomach, thighs) |
Reddish |
Very Pale |
Pale with Beige Tint |
Light Brown, Olive |
Dark Brown |
Do you have freckles on sun exposed areas? (lower arms, face) |
Many |
Several |
Few |
Incidental |
None |
What happens when you stay in the sun too long? |
Painful Redness, Blistering,
Peeling |
Blistering followed by peeling |
Burns sometimes followed by some peeling |
Rare Burns |
Never Burns |
How easily do you turn brown or tan? |
Hardly or Not at all |
Light color Tan |
Reasonable/moderate Tan |
Tan Very Easily |
Turn Dark Brown Quickly |
Do you turn brown or tan easily serveral hours after sun exposure? |
Never |
Seldom |
Sometimes |
Often |
Always |
How does your face react to the sun? |
Very Sensitive |
Sensitive |
Normal |
Very Resistant |
Never had a problem |
When did you last expose your skin to the sun? (tanning bed, use of self-tanning creams, or sun-bathing)
|
More than 3 months
ago |
2-3 months ago |
1-2 months ago |
Less Than 1 month ago |
Less than 2 weeks ago |
Do you intentionally expose the area to be treated in the sun? (tanning bed, use of self-tanning creams,
or sun-bathing) |
Never |
Hardly Ever |
Sometimes |
Often |
Always |