Sun Damage Survey - January 2017 Question Title * 1. What is your Name and Surname? Question Title * 2. Which Renewal Institute branch do you visit most often? Bedfordview Brooklyn Cape Quarter Claremont Constantia Fourways Hillcrest Illovo Irene Morningside Parkhurst Stellenbosch Umhlanga West Rand Willowbridge Question Title * 3. If you would like us to update your e-mail address on our client database, please fill in your current e-mail address below? Question Title * 4. Do you have visible sun damage on your skin? Yes No Question Title * 5. Sun damage accounts for 80-90% of ageing on the skin and is the main contributor to skin damage. Which of the following signs can you see on your skin: Pigmentation marks (dark spots or patches) Fine lines Deeper wrinkles Dryness Rough texture Melanoma (skin cancer) All of the above None of the above Question Title * 6. On which area of the face, or body, do you have visible sun damage: Forehead Around the eyes Around the mouth Cheeks Neck Jawline I don't have sun damage / pigmentation Other (please specify) Question Title * 7. Have you ever had any treatment for sun damage? Yes No Question Title * 8. Which of the following treatment(s) have you had to treat sun damage? Microdermabrasion Chemical Peels Laser Treatment Radiofrequency Treatment Topical Products Other (please specify) Question Title * 9. How often do you apply sun protection? Only in summer Only when on holiday Every day, in the morning Every day, and I reapply during the course of the day Only when I remember Only when I know I'll be exposed to direct sunlight Only when I've sunburnt Never Other (please specify) Question Title * 10. Do you know what ingredients to look out for, and what to avoid, in a sunscreen? Yes No Question Title * 11. Do you know the difference between UVA and UVB rays? Yes No Question Title * 12. Do you rely on the SPF in your daily moisturiser or foundation, or do you apply an additional sunscreen daily? I rely on my other skin care products for SPF properties I apply an additional SPF product at the end of my skincare routine, daily Question Title * 13. Did you know you can use oral supplements for effective sun protection? Yes No Tell me more about this Question Title * 14. What are you doing to prevent sun damage on your skin? Apply sunscreen daily I wear a hat and protective clothing when outside I avoid direct sun exposure between 10am - 3pm, when the sun is at its hottest I avoid the sun completely All of the above Nothing, I love soaking up the sun Other (please specify) Question Title * 15. Skin damage can take as long as 20 to 30 years to show noticeable signs on your skin such as dark spots, dryness, melanoma, wrinkles and deep lines. Thinking about your own use of SPF, many years ago, would you be concerned about your current level of skin damage? Yes No I don't know - I would like to find out more about my current skin condition, please contact me. Question Title * 16. What products are you incorporating into your skin care regime to protect and correct sun damage: Daily SPF to protect the skin from UVA & UVB rays Daily anti-oxidant application (or oral supplement) for free radical protection Daily night time application of of retinol for skin rejuvenation properties Weekly exfoliation at home to improve skin texture Regular (monthly) in-clinic treatments such as chemical peels, skin needling etc. All of the above None of the above Other (please specify) Question Title * 17. Do you know how a SPF works and how long it gives you protection? Yes No I don't know - please send me more information Question Title * 18. Have you ever used a sun bed for tanning, and how often? Yes - frequently (weekly / monthly) Yes - for special occasions Yes - years ago No, never Question Title * 19. Would you like a Renewal Institute staff member to contact you about your skin’s sun damage & schedule an appointment? Yes No Done
