|What is the color of your eyes?||Light blue, Grey, Green||Blue, Grey 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
|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: _____
|When did you last expose your body to sun (or artificial
|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.
Skin Type Score – Fitzpatrick Skin Type
|over 30||V -VI|
TYPE 1: Highly sensitive, always burns, never tans. Example: Red hair with freckles
TYPE 2: Very sun sensitive, burns easily, tans minimally. Example: Fair skinned, fair haired Caucasians
TYPE 3: Sun sensitive skin, sometimes burns, slowly tans to light brown. Example: Darker Caucasians.
TYPE 4: Minimally sun sensitive, burns minimally, always tans to moderate brown. Example: Mediterranean type Caucasians.
TYPE 5: Sun insensitive skin, rarely burns, tans well. Example: Some Hispanics, some Blacks
TYPE 6: Sun insensitive, never burns, deeply pigmented. Example: Darker Blacks.