MediCaddy Skin Analysis Questionnaire

Let's start your personalized skin analysis! 📥

Private · MediCaddy Skin Analysis

Before your session, please answer a few quick questions about your skin, lifestyle, and skincare habits. This helps us create tailored skincare recommendations designed specifically for you.

⏱ Takes about 5–10 minutes to complete.

MediCaddy Skin Analysis Questionnaire

Section 1 - Your Personal Information

1-1. Full Name (Please enter your full name)

This field is required.

1-2. Nationality * (Please enter your nationality)

This field is required.

1-3. Date of Birth * (Please enter date, month, and year of your birth)

Please select your date of birth.

1-4. Gender * (Please enter your gender)

Female
Male
Other
Prefer not to say

Please select an option.

MediCaddy Skin Analysis Questionnaire

Section 2 - Your Main Skin Concerns

2-1. What about your skin bothers you the most when you look in the mirror? (wrinkles, sagging, lack of colour, etc.) *

This field is required.

2-2. How would you describe your primary skin type? *

Dry
Oily
Combination
Sensitive
Not sure

Please select an option.

2-3. Does your skin become sensitive or irritated easily? (e.g., redness, itching, burning) *

Yes
No

Please select an option.

2-4. If you had to describe your skin in one sentence, what would it be? *

This field is required.

MediCaddy Skin Analysis Questionnaire

3. Your Skincare Routine

3-1. What does your usual skincare routine look like? * (e.g., Cleanser, Toner, Serum, Moisturizer, Night Cream - list products/steps)

This field is required.

3-2. How often do you use sunscreen (SPF 30+)? *

Every day
Sometimes
Rarely / Almost never

Please select an option.

3-3. Have you received any skin treatments (professional facials, peels, etc.) recently? * (If yes, please specify when and what treatments)

This field is required.

MediCaddy Skin Analysis Questionnaire

4. Lifestyle Factors

4-1. How would you describe your sleep pattern? *

Regular (7-9 hours consistently)
Irregular (Varies day-to-day)
Not enough sleep (Less than 6 hours often)

Please select an option.

4-3. How would you describe your diet? *

Healthy / Balanced (High in fresh foods, low sugar)
Average (Mix of healthy and convenient foods)
Spicy / Processed foods often

Please select an option.

MediCaddy Skin Analysis Questionnaire

5. Medical & Treatment History

5-1. Please indicate if you have had any of the following aesthetic treatments before *

Laser treatments (e.g., toning, fractional)
Skin boosters (e.g., Rejuran, Juvelook)
Botox / Fillers
Peels / Facials
Dermatology prescribed medication
None
Other:

Select at least one option. "None" cannot be combined with other choices.

5-2. Do you have any known allergies or underlying medical conditions we should know about? * (e.g. cosmetics, food, medication)

This field is required. Enter "None" if not applicable.

MediCaddy Skin Analysis Questionnaire

6. Your Preferred Skin Improvement Style & Expected Result

6-1. What specific change are you hoping to achieve through today’s analysis and consultation? *

This field is required.

6-2. What’s your preferred approach to skin improvement? *

Natural and gradual improvement
Faster visible improvement
Strong / noticeable results

Please select an option.

6-3. What method do you prefer for skin care? *

Mostly home skincare
Mostly clinic treatments
Combination of both

Please select an option.

6-4. What matters most to you when choosing treatments? * (Select all that apply)

Seeing the best possible results
Minimizing side effects/risks
Cost-effectiveness and budget
1:1 Consultation and guidance during and after treatment
Other:

Select at least one option. If you choose "Other," please add details.

MediCaddy Skin Analysis Questionnaire

Personal Information Use Agreement

MediCaddy collects and uses your personal information for the purpose of providing personalized skin analysis, skincare recommendations, and medical consultation coordination.

The information you provide in this form may be used for the following purposes:

Understanding your skin condition and lifestyle factors
Providing personalized skincare and treatment recommendations
Coordinating consultations with dermatology clinics if requested
Improving MediCaddy's skin analysis and consultation services

Your personal information will be handled securely and will not be shared with third parties without your consent, except when necessary to coordinate medical consultations with partner clinics.

All information will be managed in accordance with applicable privacy and data protection regulations.

By submitting this form, you agree that MediCaddy may collect and use your information for the purposes described above.

I agree to the collection and use of my personal information.

You must agree to continue.

MediCaddy Skin Analysis Questionnaire

Response submitted

Thank you for taking the time to complete this questionnaire.

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