Skin Type Assessment | Bravo Medical Aesthetics

info@bravomedicalaesthetics.co.uk

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Bravo Medical Aesthetics

FITZPATRICK SKIN TYPE QUESTIONNAIRE

Please fill out below as accurately as possible as this will determine your treatment plan.

Please read the scoring options on the chart and tick the below choices for each category as appropriate.

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Full Name

Ethnicity

Email Address

Which options have you scored 0?

Eye Colour

Natural Hair Colour

Non-Exposed Skin Colour

Freckles on Non-Exposed Skin

Long Sun Exposure with no Sunblock

Degree of Tanning

Turns Brown within Several Hours

Face's Reaction without Sunblock

Last Exposure to Sun

Have You Exposed the Treatment Area to the Sun?

None of the above

Which options have you scored 1?

Eye Colour

Natural Hair Colour

Non-Exposed Skin Colour

Freckles on Non-Exposed Skin

Long Sun Exposure with no Sunblock

Degree of Tanning

Turns Brown within Several Hours

Face's Reaction without Sunblock

Last Exposure to the Sun

Have You Exposed the Treatment Area to the Sun?

None of the above

Which options have you scored 2?

Eye Colour

Natural Hair Colour

Non-Exposed Skin Colour

Freckles on Non-Exposed Skin

Long Sun Exposure with No Sunblock

Degree of Tanning

Turns Brown within Several Hours

Face's Reaction without Sunblock

Last Exposure to the Sun

Have You Exposed the Treatment Area to the Sun?

None of the above

Which options have you scored 3?

Eye Colour

Natural Hair Colour

Non-Exposed Skin Colour

Freckles on Non-Exposed Skin

Long Sun Exposure with No Sunblock

Degree of Tanning

Turns Brown within Several Hours

Face's Reaction without Sunblock

Last Exposure to the Sun

Have You Ever Exposed the Treatment Area to the Sun?

None of the above

Which options have you scored 4?

Eye Colour

Natural Hair Colour

Non-Exposed Skin Colour

Freckles on Non-Exposed Skin

Long Sun Exposure with No Sunblock

Degree of Tanning

Turns Brown within Several Hours

Face's Reaction without Sunblock

Last Exposure to the Sun

Have You Exposed the Treatment Area to the Sun?

None of the above

Your Skin Type is based on the total score accumulated on your choices above. Please add each category based on their scores (i.e.: if you have 2 items ticked under score 3, that will accumulate 6 points on that category).

I declare that the info I’ve provided is accurate & complete. I understand that false or incorrect information may adversely affect the result of my treatment and may invalidate my insurance cover.

Thanks for submitting!

info@bravomedicalaesthetics.co.uk

Clinic locations: Peterborough, Newport Pagnell, Chatteris and Ely

+447488328935

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