Skin Health Questionnaire

Please rate each of the following by ticking the box from 1 (Excellent/None) to 5 (Severe/Poor).

This questionnaire helps assess your skin’s current condition and identify potential underlying contributors to skin problems.

Skin Health Questionnaire

How would you rate the overall health and appearance of your skin?

Do you experience frequent acne, pimples, or breakouts?

Do you have visible redness, flushing, or inflammation in your skin?

Do you suffer from eczema, dermatitis, rosacea, or psoriasis?

Is your skin showing signs of ageing (fine lines, sagging, dullness)?

How often do you consume sugar or processed foods?

Do you experience bloating, gas, or gut-related issues?

Have you had a history of food intolerances or allergies?

Are you regularly exposed to mould in your home or workplace?

Do you use topical creams with chemical or synthetic ingredients?

Have you had recent or multiple vaccinations in the past 2 years?

Do you have dental amalgams or past exposure to heavy metals?

Do you feel you are under ongoing stress or emotional strain?

Do you have poor sleep quality or trouble falling/staying asleep?

Do you get regular sun exposure without protection?

Is your skin often dry, itchy, or reactive to products?

Do you notice hyperpigmentation, melasma, or uneven skin tone?

Do you have hair thinning, brittle nails, or slow wound healing?

Do you often feel fatigued, foggy, or low in energy?

Do you currently take or have taken long-term medications or antibiotics?

Please enter your primary contact info to join the Skin Club and Get Your Score!

Skin Health Questionnaire

How would you rate the overall health and appearance of your skin?

Do you experience frequent acne, pimples, or breakouts?

Do you have visible redness, flushing, or inflammation in your skin?

Do you suffer from eczema, dermatitis, rosacea, or psoriasis?

Is your skin showing signs of ageing (fine lines, sagging, dullness)?

How often do you consume sugar or processed foods?

Do you experience bloating, gas, or gut-related issues?

Have you had a history of food intolerances or allergies?

Are you regularly exposed to mould in your home or workplace?

Do you use topical creams with chemical or synthetic ingredients?

Have you had recent or multiple vaccinations in the past 2 years?

Do you have dental amalgams or past exposure to heavy metals?

Do you feel you are under ongoing stress or emotional strain?

Do you have poor sleep quality or trouble falling/staying asleep?

Do you get regular sun exposure without protection?

Is your skin often dry, itchy, or reactive to products?

Do you notice hyperpigmentation, melasma, or uneven skin tone?

Do you have hair thinning, brittle nails, or slow wound healing?

Do you often feel fatigued, foggy, or low in energy?

Do you currently take or have taken long-term medications or antibiotics?

Please enter your primary contact info to join the Skin Club and Get Your Score!

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