Receive Your Tailored Skin Plan from Dr Ansulette Kay

Skin Hydration Assessment

How Does Your Skin Feel Without Moisturizer?

Check all that apply

I rarely need moisturiser, even after cleansing.I need moisturiser daily to avoid dryness/tightness.I need moisturiser multiple times a day for comfort.None of the above

Skin Oil Production

Describe Your Skin's Oiliness

Check all that apply

My facial skin is rough or dry.My facial skin is oily in some areas.My face is very oily.My face is uncomfortable if I do not use a moisturiser.I like the feel of heavy creams and oils on my skin.My skin is both oily and sensitive.My skin gets oily but feels tight if I use harsh cleansers.None of the above

Skin Sensitivity & Inflammation

Recent Skin Concerns (Past 4 Weeks)

Check all that apply

Acne (pimples)Facial redness and flushingStinging or burningA rash with itching, scaling, and rednessIrritation from shaving the faceNone of the above

Hyperpigmentation Concerns

Do You Want to Treat Dark Spots?

Choose one

Not mentionedMy skin tone is even, with no dark spots.I have freckles or dark spots, and I do not want to remove them.I have dark spots, and I'd like to treat them.

Lifestyle Habits

Check all that apply to you:

I have smoked over 50 cigarettes or cigars in my life.I am exposed to secondhand smoke weekly.I currently smoke cigarettes or vapeI often get less than 7 hours of sleep a night.I feel stressed at least 2 hours a day.I eat sugary foods over three times a week.I exercise less than 3 hours a week.I do not eat fruit or vegetables every day.None of the above

Suncare Habits

Check all that apply to you:

I have been to a tanning bed more than three times.I spend over 3 hours a week outdoors for work or leisure.I spend over 3 hours a week close to a window during daylight hours (including driving).My face has been sunburned and peeled more than twice in my life.I do not take daily antioxidant supplements like vitamins E and C.One of my parents has more wrinkles than others their age.I do not wear sunscreen every dayI do not wear sunscreen during outdoor activitiesNone of the above

Eye Product Selection

Help Us Choose the Right Eye Product

Please tell us about your eye issues (check all that apply):

Dark CirclesDrynessFine lines and wrinklesItching or rednessPuffiness or bagsNone of the above

Additional Skin Concerns (Face)

Check all the following concerns that you would like to address. If nothing applies, select "None of the above":

Dry LipsDry skinEczemaBroken blood vessels on the faceLoss of fullness in the face (thin face)Loss of fullness in the temples (upper part of the face)Sagging skinThin lipsWrinkles - frown lines between browsWrinkles - around the mouthWrinkles - around eyesWrinkles - foreheadWrinkles - on cheeksPsoriasisShaving irritationNone of the above

Additional Skin Concerns (Body)

Check all the following concerns you would like to address. If nothing applies, select "None of the above":

Acne ScarsBroken blood vessels on the bodyCelluliteStretch marksExcess body fatExcess chin fatExcess facial or body hairHands - brown spots and sun damageHands - thin and bonyWeak nailsSagging skinScalp redness or flakingHair loss or thinning hairNone of the above

Sunscreen Tint Preference

Help Us Color-Match Your Sunscreen

Choose one

Not mentionedTinted (Light)Tinted (Medium)Tinted (Tan)Tinted (Dark)Untinted (White Or Clear)No Preference

Gender

Not mentionedFemaleMalePrefer Not to Say

Age

Not mentionedUnder 2020's30's40's50's60+

Skin Allergies

If you have ever had any adverse reactions to any skincare products, please list them below

What is your ethnic skintype?

(Asian, African, Indian etc)

Do you have any medical conditions or take medications that affect your skin.

In your own words what is your main skincare goal.

Photo Upload:

A few selfie tips: Remove glasses and pull your hair back. Try to minimise shadows as much as possible. Centre your entire face and keep a neutral expression. For best results, use your mobile device.