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Skin and hair consultation form
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Name and surname:
Age:
Gender:
Occupation:
Skin type:
Mobile:
Date:
Consultant’s name
Are you under the supervision of a skin and hair doctor? (Reason: No
Do you use any special medicine? (Name of medicine: No
Do you have a history of allergies and sensitivities to health, cosmetic or skin and hair care products?
1) Which of the following items do you consume regularly?
1) Scrap or sheet mask
2) Anti-wrinkle
3) Washing gel/wipe milk
4) Zadlak
2) Which of the following situations have you experienced on your face?
1) Dryness and stretching of the facial skin after washing
2) Strong need for moisturizing cream during the day
3) Skin sensitivity to any external factor
4) Itching, burning or redness of the skin after using cosmetics
5) Rapid fattening of the skin and shining of the frontal area
6) Permanent feeling of fat on the skin
7) Blackheads and open skin pores
8) Dryness of the cheeks and fat on the forehead, around the forehead and chin
9) Peeling or itching of the skin, especially in the cold season
3) Which of the following is your main concern about your facial skin right now?
1) Wrinkles, darkness or puffiness around the eyes
2) Severe dryness of the skin
3) Skin spots
4) Wrinkles and lines on the skin surface
5) Pimple or acne
6) Open pores or blackheads
4) Which of the following is true about your skin?
1) Dry skin
2) Darkness of the body skin
3) Dryness and cracking of the skin of the feet
4) oily skin (with acne)
5) Eczema or psoriasis
6) Body skin cracks
5) Which of the following products do you use regularly?
1) Softening and conditioning
2) anti-dandruff shampoo
3) Hair oil
4) Anti-shedding shampoo
5) Hair mask (inside or outside the bathroom)
6) Hair serum
6) Which of the following is true about your hair?
1) Dry scalp
2) Dry or frizzy hair
3) Shameful
4) Oiliness of the scalp
5) Brittle hair
6) Hair loss
7) Scalp itching
8) Lack of volumization of hair
9) Scalp or dandruff
7) Which of the following items do you use alternately?
1) Hair color
2) Hair iron or hot hair dryer
3) Smooth or regular oven
4) Declaration
5) Hair gel or gel
6) Keratin
8) Which of the following issues have you experienced about your nails?
1) presence of depression or groove in the nail
2) dullness or dullness of the nail
3) layering, brittleness or cracking of the nail
4) Dryness and detachment of nail skin
9) Which of the following is true about you?
1) A lot of thirst
2) Feeling of low thirst
3) Feeling of heat
4) Feeling cold
5) Good digestive power
6) Low digestive power (sour stomach, etc.)
10) Do you have any concerns or experience regarding the following materials?
1) Osteoporosis
2) Damage to ligaments and tendons
3) The need to increase muscle volume
4) Arthritis
5) Joint pain
6) Physical damage to bones
11) Do you want to work with Nafis as a consultant?
1) Yes
2) No
This post is written by MN_H_KA