Skin Typing Matrix
Choice Health & Wellness
Tamera Nolan ARNP
415 W. Third Ave
Moses Lake, WA 98837
Name
First Name
Last Name
My ethnic origin is closes to:
Very fair (Celtic and Scandinavian)
Fair-skinned Caucasian with light hair and light eyes
Pale-skinned Caucasian with dark hair and dark eyes
Olive-skinned (Mediterranean, some Asian, some Hispanic)
Dark-skinned (Middle eastern, Hispanic, Asians, some African)
Very dark-skinned (African)
My eye color is:
Light Blue (0)
Blue/Green (1)
Green/Gray/Golden (2)
Hazel/Light Brown (3)
Brown (4)
My natural hair when I was 18:
Red (0)
Blonde (1)
Light Brown (2)
Dark Brown (3)
Black (4)
The color of my skin that is not normally exposed to the sun:
Pink to Reddish (0)
Very Pale (1)
Pale with a beige tan (2)
Light Brown (3)
Medium to dark brown (4)
Dark brown, black (5)
If I go into the sun for an hour or so without sunscreen and have not been out in the sun for weeks, my skin will:
Burn, blister and peel (0)
Burn, then when the burn resolves there is little to no color change (1)
Burn, but then turns to a tan in a few days (2)
Get pink, but then turns into a tan quickly (3)
Just tan (4)
Just gets darker (5)
My skin is so dark I can't tell (6)
When was the last time the area to be treated was exposed to natural sunlight, tanning booths or artificial tanning cream?
Longer than a month ago (0)
Within the past month (1)
within the past two weeks (2)
Within the past week (3)
If you sustain an injury to your skin such as a cut, burn, or bruise, how long does it take to resolve without any hyperpigmentation?
What happens when you get an insect bite?
How did you hear about us? Can we thank someone for reffering you?
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