Skin Revitalization Quiz | Patrick J. O'Neill, MD Plastic Surgeon

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Skin Revitalization Quiz

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What is your primary skincare concern?*
- Pigmentation
- Wrinkles
- Skin Rejuvenation
- Sagging Skin

What is your skin type?*
- Light
- Medium
- Dark

Do you have age spots, sun damage, or pigmentation that you would like to reduce?*
- Yes
- No

Do you have facial wrinkles that you want to reduce?*
- Yes
- No

Do you have tiny red veins on your face or suffer from rosacea?*
- Yes
- No

Do you have scars from acne?*
- Yes
- No

Do you have wrinkles around the eyes or mouth?*
- Yes
- No

INFORMATION
Full Name*
Email Address*
Phone Number*

Skin Revitalization Quiz

1

2

3

4

5

6

7

8

What is your primary skincare concern?*
- Pigmentation
- Wrinkles
- Skin Rejuvenation
- Sagging Skin

What is your skin type?*
- Light
- Medium
- Dark

Do you have age spots, sun damage, or pigmentation that you would like to reduce?*
- Yes
- No

Do you have facial wrinkles that you want to reduce?*
- Yes
- No

Do you have tiny red veins on your face or suffer from rosacea?*
- Yes
- No

Do you have scars from acne?*
- Yes
- No

Do you have wrinkles around the eyes or mouth?*
- Yes
- No

INFORMATION
Full Name*
Email Address*
Phone Number*

245 Seven Farms Dr #210

Charleston, SC 294921

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