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Genetic Disposition
| Score |
0 |
1 |
2 |
3 |
4 |
| What are the color of your eyes? |
Light blue, Gray, Green |
Blue, Gray or Green |
Blue |
Dark Brown |
Brownish Black |
| What is the natural color of your hair? |
Sandy Red |
Blond |
Chestnut/Dark Blond |
Dark Brown |
Black |
| What is the color of your skin (non exposed areas)? |
Reddish |
Very Pale |
Pale with Beige tint |
Light Brown |
Dark Brown |
| Do you have freckles on unexposed areas? |
Many |
Several |
Few |
Incidental |
None |
Total score for Genetic Disposition: _____
Reaction to Sun Exposure
| Score |
0 |
1 |
2 |
3 |
4 |
| What happens when you stay in the sun too long? |
Painful redness, blistering, peeling |
Blistering followed by peeling |
Burns sometimes followed by peeling |
Rare burns |
Never had burns |
| To What degree do you turn brown? |
Hardly or not at all |
Light color tan |
Reasonable tan |
Tan very easy |
Turn dark brown quickly |
| Do you turn brown within several hours after sun exposure? |
Never |
Seldom |
Sometimes |
Often |
Always |
| How does your face react to the sun? |
Very sensitive |
Sensitive |
Normal |
Very resistant |
Never had a problem |
Total score for Reaction to Sun Exposure: _____
Tanning Habits
| Score |
0 |
1 |
2 |
3 |
4 |
| When did you last expose your body to sun (or artificial sunlamp/tanning cream)? |
More than 3 months ago |
2-3 months ago |
1-2 months ago |
Less than a month ago |
Less than 2 weeks ago |
| Did you expose the area to be treated to the sun? |
Never |
Hardly ever |
Sometimes |
Often |
Always |
Total score for Tanning Habits: _____
Add up the total scores for each of the three sections for your Skin Type Score.
Fitzpatrick Skin Type
| Score |
0-7 |
8-16 |
17-25 |
25-30 |
Over 30 |
| Skin Type |
I |
II |
III |
IV |
V/VI |
*Note: The above information should not be consider medical advice in any way. If you are considering laser, please contact your local laser technician for advice and help making decisions concerning your treatment.
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