Client form

Choose Skin Type Chart

Alternate Fitzpatrick scoring chart.

Your information is kept confidential and used only for your treatment planning. Prefer paper? Complete this form at the clinic: arrive 10 minutes early.

Total Values:

Eye Colour
(0: Light Blue Grey/Green, 1: Blue Grey/Green, 2: Blue, 3: Brown/ Dark Brown, 4: Brownish Black)

Natural Hair Colour
(0: Sandy red, 1: Blonde, 2: Chestnut/ Dark Blonde, 3: Brown/ Dark Brown, 4: Black)

Natural skin colour
(0: Reddish, 1: Very Pale, 2: Pale With Beige Tint, 3: Light Brown, 4: Dark Brown)

Freckles
(0: Mary, 1: Several, 2: Few, 3: Incidental, 4: None)

Too Long in Sun
(0: Painful Redness / Blister/ Peels, 1: Blistering Then Peel , 2: Burns Some Then Peel, 3: Rarely Burns, 4: Never Burns)

Degree of Turning Brown
(0: Hardly or Not At All, 1: Light Colour Tan , 2: Reasonable Tan, 3: Tans Easily, 4: Turn Dark Brown Very Quickly)

Turn Brown Hours After Exposure
(0: Never, 1: Seldom , 2: Sometimes, 3: Often, 4: Always)

Face Response to Sun
(0: Very Sensitive, 1: Sensitive, 2: Normal, 3: Very Resistant, 4: Never a Problem)

Last Exposure to Tanning / Tan Creams
(0: 3 Months Ago, 1: 2-3 Months Ago, 2: 1-2 Months Ago, 3: Less Than 1 Month Ago, 4: Less Than 2 Weeks Ago)

Sun Exposure to Treatment Area
(0: Never, 1: Hardly Ever, 2: Sometimes, 3: Sometimes, 4: Always)

Total Value

Fitzpatrick scale

Add up the ten answers above, then read your skin type from the total.

Score	Fitzpatrick scale
0–7	1
8–16	2
17–25	3
26–30	4
Over 30	5–6

Your practitioner confirms the final skin type at your consultation; the laser settings follow from it.

FAQ

About this form

Straight answers from the Oxyderm team. Still wondering about something? Call us. We love these questions.

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Do I have to complete this form online?

No. You can complete it at the clinic before your appointment. Completing it online simply saves you time on the day.

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Can I save and come back later?

Yes. Your answers are kept in your browser until you submit, so you can close the page and finish later on the same device.

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Who sees my medical information?

Only the practitioners involved in your care. We follow Alberta privacy legislation; see our privacy policy.

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Why do you ask about medications and medical history?

Some medications and conditions affect how skin responds to laser, peels and injectables. Knowing them lets us choose safe settings and avoid complications.

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Do treatments require downtime?

While many of our services are designed to have minimal downtime, this depends on the specific treatment. We’ll provide aftercare instructions to ensure you recover quickly.

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Are consultations required before starting treatments?

Yes, we recommend consultations to understand your needs and create a personalized treatment plan.

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