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What is your biological sex?
*
Female
Male
Sex and hormones affect skin.
What is your age?
Under 20
20s
30s
40s
50s
60s +
How would you describe the prominence and depth of your fine lines and wrinkles?
*
Barely noticeable
Visible but not deep
Quite prominent and moderately deep
Very prominent and deep
Where are you primarily noticing the appearance of fine lines and wrinkles?
Forehead
Between the eyebrows
Crow's feet (around the eyes)
Under the eyes
Temples
Upper eyelids
Nasolabial folds (laugh lines)
Mouth corners (marionette lines)
Neck
Other
Select all that apply
What do you believe is the primary cause of your skin aging?
Genetics
Sun exposure
Environmental pollutants
Stress
Smoking
Inadequate skincare
Other
Select all that apply
Have you used any treatments or products to combat fine lines and wrinkles in the past?
Over-the-counter anti-aging creams/serums
Prescription anti-aging creams/serums
Botox or fillers
Laser treatments
At-home dermarolling or micro-needling
None
Other
Select all that apply
Are you currently using any specific anti-aging skincare products?
Are you open to prescription anti-aging treatments if recommended by a dermatologist?
Yes
No
How would you rate your skin's sensitivity when using new products?
Not at all sensitive
Slightly sensitive
Moderately sensitive
Very sensitive
Extremely sensitive
What's your primary skin type?
Dry
Oily
Cobination
Normal
Sensitive
How often are you exposed to direct sunlight without protection?
Daily
Occasionally
Rarely
Never
Do you have a history of smoking?
Current smoker
Former smoker
Never smoked
Do you hydrate adequately daily?
Yes, I drink more than 8 glasses of water.
I drink about 4-7 glasses of water.
I rarely drink up to 3 glasses of water.
Do you have any other skin concerns alongside fine lines and wrinkles?
Dryness
Redness
Irritation
Sagging
Hyperpigmentation
Other
Select all that apply
Are there any skincare ingredients or products you are allergic or sensitive to?
Niacinamide
Ceramides
Benzoyl peroxide
Salicylic acid
Retinoids (e.g., Retin-A, tretinoin)
Alpha hydroxy acids (e.g., glycolic acid, lactic acid)
Fragrances
None
Other
Select all that apply
Which lifestyle factors might be impacting your skin's aging process?
Diet
Sleep habits
Stress levels
Exercise habits
Frequent exposure to air conditioning or heating
Other
Select all that apply
Have you experienced any side effects from anti-aging products in the past?
No
Redness or irritation
Dryness or peeling
Allergic reaction
Other
Select all that apply
Briefly describe your current skincare routine
How long have you been concerned about your skin's aging?
Less than a year
1-2 years
3-5 years
More than 5 years
What goals do you hope to achieve with your anti-aging treatment?
Reduce fine lines and wrinkles
Enhance skin's natural radiance
Improve skin elasticity and firmness
Address skin sagging
Maintain overall skin health
Select all that apply
Enter your email to get your skin state evaluation
Glowy AI ensures the confidentiality of your personal information.
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