What is your age group?

Under 18

18–25

26–35

36–45

46–55

56+

What is your gender?

Female

Male

Other/Prefer not to say

How would you describe your skin type?

Dry

Tight feeling after cleansing, flaky patches, small pores, rarely breaks out

Oily

Shiny throughout the day, large pores, prone to blackheads and breakouts

Combination

Oily T-zone (forehead, nose, chin) but normal to dry cheeks

Sensitive

Easily irritated by products, prone to redness and stinging sensations

Normal

Balanced, rarely breaks out, minimal sensitivity, small to medium pores

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

Acne

Blackheads, whiteheads, inflamed pimples

Wrinkles & Aging

Fine lines, loss of firmness, sagging

Pigmentation & Dark Spots

Age spots, melasma, post-acne marks

Dryness & Dehydration

Tight, flaky, or rough texture

Sensitivity & Redness

Irritation, burning, or stinging reactions

Uneven Texture

Rough patches, enlarged pores, bumpy feel

What type of climate do you live in?

Hot & Humid

High temperatures with high humidity year-round

Hot & Dry

High temperatures with low humidity (desert climate)

Temperate

Moderate temperatures with seasonal changes

Cold & Dry

Low temperatures with low humidity

How much time do you spend outdoors daily?

Minimal (Under 30 minutes)

Mostly indoors, brief outdoor exposure

Moderate (30 minutes - 2 hours)

Regular outdoor activities, commuting

Several Hours (2-6 hours)

Outdoor job, sports, or hobbies

Most of the Day (6+ hours)

Outdoor work or lifestyle

Do you live in an area with high air pollution?

Yes

Urban area with visible smog, traffic, industrial activity

No

Rural, suburban, or low-pollution area

How would you describe your indoor environment?

Air Conditioned

Controlled temperature and humidity

Heated (Winter)

Dry heat, low humidity indoors

Natural Ventilation

Windows open, fresh air circulation

How many hours of sleep do you get per night on average?

Under 5 hours

5-6 hours

7-8 hours

9+ hours

How would you describe your typical diet?

Balanced & Varied

Plenty of fruits, vegetables, whole grains, lean proteins

Moderately Healthy

Some healthy foods, occasional processed meals

Mostly Processed

Frequent fast food, packaged meals, limited fresh foods

Irregular Eating

Skipped meals, inconsistent eating patterns

How much water do you drink daily?

Under 4 glasses

4-6 glasses

7-8 glasses

9+ glasses

How often do you exercise?

Daily

30+ minutes of physical activity every day

3-5 times per week

Regular workout routine

1-2 times per week

Light, occasional exercise

Rarely/Never

Sedentary lifestyle

How would you rate your current stress level?

Low Stress

Generally relaxed, good work-life balance

Moderate Stress

Some pressure, manageable daily stress

High Stress

Constant pressure, overwhelming responsibilities

Do you experience hormonal changes that affect your skin?

Yes, Significantly

Menstrual cycle, pregnancy, menopause, or hormonal conditions clearly affect skin

Occasionally

Minor changes during certain times

Not Noticeably

Skin remains fairly consistent

How often do you experience digestive issues?