Skip to content
+31 6 3800 3872
info@huidspecialist.eu
Mon - Fri: 9:00 - 18:30
huidspecialist
Specialist in huidverbetering en huidverzorging.
Succesverhalen
Succesverhalen
Getuigenissen
Voor & Na
Mijn Verhaal
Onderzoek
Wat is je microbioom?
Het geheim van een perfecte huid
Huidallergie-epidemie
Misleiding door natuurlijke cosmetica
Het oplossen van de huidallergie-epidemie
FAQs
Vragenlijst
Which skin problems do you have?
TSW | Pre-program Questionnaire
TSW | Post-program Questionnaire
Business Analysis | Salons
Business Analysis | General
Contact
Menu
Succesverhalen
Succesverhalen
Getuigenissen
Voor & Na
Mijn Verhaal
Onderzoek
Wat is je microbioom?
Het geheim van een perfecte huid
Huidallergie-epidemie
Misleiding door natuurlijke cosmetica
Het oplossen van de huidallergie-epidemie
FAQs
Vragenlijst
Which skin problems do you have?
TSW | Pre-program Questionnaire
TSW | Post-program Questionnaire
Business Analysis | Salons
Business Analysis | General
Contact
4 Month Skin Fitness Program
Diagnostic Questionnaire
Acne
Pre-Program Consultation
Name
Age
Email
When did your acne first start?
Where is it located?
How old are you now?
How have you been trying to manage it?
Q1: Please tick each symptom you are experiencing:
sensitive skin
red and inflamed skin
whiteheads
blackheads
small red tender bumps (papules)
pimples (pustules) with pus at their tips
large, solid, painful lumps beneath the surface of the skin (nodules)
painful, pus-filled lumps beneath the surface of the skin (cystic lesions)
very oily areas
bumps/uneven skin texture
scarring/discoloured spots
From 0-10 (10 being awful) please rate the severity of each symptom selected in Q1 :
Q2: 'Sensitive skin'
0
1
2
3
4
5
6
7
8
9
10
Q3: 'Red and inflamed skin'
0
1
2
3
4
5
6
7
8
9
10
Q4: 'Whiteheads'
0
1
2
3
4
5
6
7
8
9
10
Q5: 'Blackheads'
0
1
2
3
4
5
6
7
8
9
10
Q6: 'Small red tender bumps (papules)'
0
1
2
3
4
5
6
7
8
9
10
Q7: 'Pimples (pustules) with pus at their tips'
0
1
2
3
4
5
6
7
8
9
10
Q8: 'Large, solid, painful lumps beneath the surface of the skin (nodules)'
0
1
2
3
4
5
6
7
8
9
10
Q9: 'Painful, pus-filled lumps beneath the surface of the skin (cystic lesions)'
0
1
2
3
4
5
6
7
8
9
10
Q10: 'Very oily areas'
0
1
2
3
4
5
6
7
8
9
10
Q11: 'Bumps/uneven skin texture'
0
1
2
3
4
5
6
7
8
9
10
Q12: 'Scarring/discoloured spots'
0
1
2
3
4
5
6
7
8
9
10
Q13: Please give details of *any* health problems you have which could compromise your immune system.
(eg. food/other allergies, sensitivities to certain substances, fungal overgrowth, gut problems, diseases such as diabetes, high blood pressure, heart disease, pregnancy, weight issues etc...).
Q14: Please give details of *any* drugs you are taking currently.
Submit Questionnaire
Schrijf u hier in
Schrijf u hier in voor hulp bij uw huidproblemen
Naam
Email
telefoonnummer
Schrijf u hier in
