PURE Skin Type Form

GENETIC DISPOSITION
Score 0 1 2 3 4
Eye Color Lt Blue, Grey, Green Blues, Grey or Green Blue Dk Brown Brownish Black
Hair Color Sandy Red Blond Chesnut/Dk Brown Dk Brown Black
Skin Color
(unexposed areas)
Reddish Very Pale Pale w/ Beige Tint Lt Brown Dk 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
Prolonged Sun Exposure Painful redness, blistering, peeling Blistering then peeling Burn then peeling Rare burns Never burn
What degree do you brown? Hardly/not at all Light tan Reasonable tan Tan very easy Turn dark brown quickly
Do you brown after several hours of sun? Never Seldom Sometimes Oftern Always
How does your face react to the sun? Very sensitive Sensitive Normal Resistant No problem

Total score for reaction to SUN EXPOSURE:

TANNING HABITS
Score 0 1 2 3 4
When did you last expose your body to ANY type of sun? 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:

SKIN TYPE GRAND TOTAL SCORE:

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