SWI: FACE AND SKIN TEST

FACE AND SKIN TEST

Name:

Birth of date: Month / Day / Year

Email:

Contact No.:

Skype No.:

Address:





Signs and symtoms


1. My face has fine lines at the side of the eyes

Never Sometimes Regular Often Constantly


2. I have a thick line from my nose to my mouth

Never Sometimes Regular Often Constantly


3. I have eczema, psoriasis, or other rashes

Never Sometimes Regular Often Constantly


4. I have a furrow between my eye brows

Never Sometimes Regular Often Constantly


5. I have lines on my forehead

Never Sometimes Regular Often Constantly


6. I have rosacea (redness on the nose and the cheeks)

Never Sometimes Regular Often Constantly


7. The skin is thick on the back of the hand

Never Sometimes Regular Often Constantly


8. My skin looks thicker on my lace

Never Sometimes Regular Often Constantly


9. I have smile lines at the side of my mouth

Never Sometimes Regular Often Constantly


10. I have dark circles under my eyes

Never Sometimes Regular Often Constantly