Skin analysis

Name and surname:*

Birthdate:

Email:*

Phone:

Address:

Observations (intolerances, known allergies):

Diagnostic form

1- The texture of your skin is:*

Thin Thick Normal Irregular; in the forehead, nose and chin area it appears thicker than in the rest of the face

2- Do you usually have acne lesions?*

Always Never Often Only once a month

3- What do your pores look like?*

I have no pores or they are imperceptible They are very dilated On my chin I have them more open than on the rest of my face They are small, I sometimes get a pimple

4- What is your skin color?*

Opaque, almost yellowish Irregular. I have pink areas and opaque areas Uniform and translucent Dull and matte

5- Do you moisturize your skin every day?*

No, my skin is already very hydrated naturally Sometimes, when my cheeks or forehead feel drier If I don't moisturize it twice a day, it feels tight Only when I remember

6- How does the weather affect you?*

In the cold I get cracks and sometimes flakes. But in summer, the appearance of my skin improves considerably My skin is a little drier in winter than in summer In summer I notice my skin is much oilier than I normally would. usual In summer, the central facial area (forehead, nose, chin) shines much brighter

7- Your skin has a touch*

Dehydrated and rough Unctuous Very shiny in the central facial area Fine and soft

8- Do you blush easily?*

Almost never Sometimes Very easily Always. For any stupid thing I turn red as a tomato and feel embarrassed...

9- Presence of marked dark circles?*

No A little Many

10- Age spots?*

No A little Many

11-Pregnant?*

Yes No

12- Do you smoke?*

Yes No

13- Presence of wrinkles?*

No A little Many

14-Are you using Villafuerte Pharmacy Creams?*

Yes No

Personal skin description and improvement goals*

Current skin care routine and what products you use*

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