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Online Evaluation Form
desarrollo
2025-09-19T14:26:06+00:00
Online Evaluation Form
Personal data
About your skin and acne
Since when have you had acne problems?
Less than 6 months
Between 6 months and 2 years
More than 2 years
Where does your acne appear?
Face
Back
Chest
Others
How would you describe your acne?
Blackheads / pimples
Red granites
Inflamed acne with pus
Scars or spots
Have you received treatments before?
Yes, dermatologist
Yes, commercial products
Yes, home remedies
No
Do you have sensitive skin or have you had allergic reactions to products?
Yes
No
Lifestyle and habits
How often do you eat fatty, dairy, or sugary foods?
Hardly ever
Sometimes
Very common
How often do you suffer from stress or lack of sleep?
Seldom
Sometimes
Very often
Goals and expectations
What is your main goal with this treatment?
Remove pimples
Reduce scars or blemishes
Improve the texture and overall appearance of my skin
Other
How committed are you to following a daily routine?
Very committed
Moderately committed
Little committed
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Attach photos
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