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Run: Skin Type Assessment Intake Form

Capture skin type, sensitivities, sun exposure, and current products in one intake form so you can recommend a personalized skincare regimen with fewer follo...

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Consent and Submission Details

I consent to the collection and use of my responses for skincare assessment and regimen recommendation. (required)

Yes No N/A

Preferred contact method

Email address

Optional. Provide only if you want follow-up about your recommendation.

What happens after I submit?

Skin Profile

Which best describes your skin type? (required)

What are your main skin concerns? (Select all that apply) (required)

Other concern

How sensitive is your skin? (required)

Sensitivity and Reactions

Known ingredients or products that cause irritation

Have you had a recent skin reaction? (required)

Describe the reaction

Any accommodation needs or preferences?

Optional. Share anything that would help us make the recommendation easier to use or understand.

Sun Exposure and Routine

How much sun exposure do you typically get on a normal day? (required)

How often do you use sunscreen? (required)

Briefly describe your current skincare routine

Current products or active ingredients in use

Optional. Include only products or ingredients you think are relevant to your skin assessment.

Get your results

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Email (required)

Your name (optional)

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