ALLSKIN | MED Retinol Challenge – Questionnaire 1 (2 Weeks)Name(Required)Clinic Name(Required)Regime Start DateDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Have you used retinol-based products before? Yes NoIf yes, which products have you used?How easy is the regime to follow?1= Very Difficult, 5= Very Easy54321Have the products caused any irritation? Yes NoIf yes, please provide further details of the type of irritation and how long it lastedIf yes, has any irritation been managed with tips provided on your regime card? Yes NoOn a scale of 1-5, what improvements have you started to see in your skin:1= No Change, 5= Significant ImprovementImprovement in skin texture54321Improvement in fine lines54321Improvement in skin brightness54321Improvement in skin hydration54321
