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Q1. Check the following symptoms that you have experienced on your facial skin:

• Redness
• Flaking
• Itchiness
• Stinging
• Swelling
• Pus
• Scabs

Q2. Key in the affected location on your face: (e.g around mouth, eyes etc)

Q4. How many times in a month do you experience these symptoms?

Q5. What was the duration of symptoms from the first time of observation?

Q6. Do your skin symptoms come up because of a change in environment?YesNo

Q7. Do your skin symptoms come up due to a change in skincare/makeup?YesNo

Q8. Any known sensitivity/allergies to ingredients? What happens when you apply it?

Q9. Do you dig and pick your skin? YesNo

Q10. Are you bothered by any of the following?

• Acne scars
• Enlarged pores
• Greasy skin
• Blackheads
• Whiteheads
• Wrinkles
• Overall skin elasticity/firmness
• Skin sagging
• Oily skin
• Rough/irregular texture of skin
• Pimples
• Itchy bumps

Q11. On a scale of 0-10 (10 = most severely affected), how would you rate how affected you are by your symptoms?

Q12. Do you have a family history of any of the following?

• Acne
• Eczema
• Rosacea

Q13. Do you think your symptoms have worsened since wearing a face mask?YesNo

Q14. What type of face mask are you currently wearing?

Q15. Please choose your skin type:Combination SkinOily SkinDry Skin

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