2704 20th St S Ste 104, Homewood, AL 35209
205-413-8599
rsvp@vitalogywellness.com

Med Spa Consultation Wellness Discovery Call

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Welcome
Event
- Injectable Days
Giveaway
- Join our Newsletter
Med-Spa Services
Financing
- NEW! PatientFi
- Cherry Financing
Wellness
Shop
Gallery
Appointment
Reviews
- Video Testimonials
Blog

Skincare QUIZ

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Skincare QUIZ

Welcome to the Future of Skin Care

Dr. Farah T. Sultan talking to her patient

Take your Skin Care Quiz Today!

Name(Required)

Email(Required)

Age(Required)

Are you?(Required)

Female

Male

What is your skin type?(Required)

I'm not sure

Dry

Normal

Combination

Oily

What are your skin goals? (choose all that apply)(Required)

Prevent wrinkles

Better, healthier skin

Address my skin problems

Are you currently(Required)

Pregnant

Breastfeeding

Postpartum (Post-pregnancy)

Experiencing menopause

Trying to get pregnant

None of the above

We can help you determine your skin type. How does your skin feel in the morning?(Required)

Dry

Oily/Shiny

Dry in some areas and oily in some areas

None of the above

How does your skin feel a few hours after using moisturizer?(Required)

Dry

Oily

Dry in some areas and oily in some areas

I don't use moisturizer

None of the above

Which skin ethnicity do you most identify with?(Required)

East/Southeast Asian skin

Caucasian skin

South Asian skin

African-American skin

Hispanic skin

Other

Does new skin care often make your skin itch, burn, or irritated?(Required)

Yes

Yes, sometimes

No

I'm not sure

Does new skin care often make your skin break out?(Required)

Yes

Yes, sometimes

No

I'm not sure

What are your skin concerns? (choose all that apply)(Required)

Acne

Dark spots or uneven tone

Wrinkles

Clogged pores

Redness

Any particular concern you really want us to focus on?(Required)

Yes, acne

Yes, dark spots

No, focus on all my concerns equally

Did you always have acne or did you recently start having acne?(Required)

I always have had acne

I always have had acne but it got worse recently

I always have had clear skin but recently started to get acne

I'm not sure

How many pimples did you get in the last week?(Required)

None

1-3

3-6

6+

How noticeable are your dark spots?(Required)

Only visible up close

Somewhat noticeable

Very noticeable

How often do you see new red inflamed pimples?(Required)

Daily

Weekly

Monthly

Rarely

Do you see more pimples around your period?(Required)

Yes

No

I don't know/I've never noticed

Your current skin care regimen consists of(Required)

Cleanser

Toner

Serum

Sunscreen or Moisturizer with SPF

Moisturizer without SPF or Face Oil

Eye Cream

Retinol or Retin-A

Do you have dark spots or discoloration after pimples?(Required)

Yes

No

I don't know/I've never noticed

You prefer your skin care to have(Required)

No fragrance

Light fragrance

Either is fine

When did you start noticing dark spots?(Required)

Throughout my whole life

After pregnancy

After menopause

After dealing with acne

I don’t remember

Are you currently taking any treatments to address these dark spots?(Required)

Skincare

Specialized treatments (laser, micro-needling, etc.)

I’m not using anything

Have these dark spots gotten better or worse recently?(Required)

Better

Worsened

I’m not sure

You prefer your skin care ingredients to be(Required)

As natural as possible

As effective as possible

Natural and effective

How would you describe your current living environment?(Required)

Dry

Neutral

Humid

I don't know

How much stress are you under?(Required)

A lot of stress

My life is stressful but under control

My life is not stressful at all

Is the air where you live polluted?(Required)

Yes

Somewhat polluted

No

I'm not sure

How much sleep do you typically get?(Required)

Under 7 hours

7-8 hours

Over 8 hours

Are you ready to address your skin concerns?(Required)

Yes

No

Would you like to book an appointment?(Required)

Yes

No

Phone(Required)

Are you currently a patient at Vitalogy Wellness & Med-spa(Required)

Yes

No

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About Us

Dr. Farah T. Sultan our Medical Director and founding physician created Vitalogy Wellness & Med-Spa with the belief that she could help her patients live a quality life while aging gracefully.

2704 20th St S Ste 104
Homewood, AL 35209

205-413-8599
rsvp@vitalogywellness.com
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Med Spa Services

Virtue RF Microneedling
PRX Dermperfexion
Injectables
HydraFacial
Motus AZ + Laser
Microneedling & Dermaplaning
PRP Therapy for skin rejuvenation
SmoothCool IPL – Pixel CO2 Laser
Exilis Ultra
Vanquish ME
Cellutone
P-Shot & Acoustic Wave
O-Shot & Femilift + Vfit

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Skincare QUIZ

Welcome to the Future of Skin Care

Take your Skin Care Quiz Today!

Get Directions

Call for an appointment!

Get In Touch

About Us

Med Spa Services

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