Melasma Patient Form To get the most out of your visit, please complete the questions below prior to your appointment. Full Name(Required)I use sunscreen -(Required) Once a day Twice a day Occasionally Never My daily sunscreen is -(Required) Clear or white (untinted) Tinted (brown) A regular 50 ml bottle of sunscreen last around-(Required) Last 2 weeks Last 2-4 weeks Last 1-2 months Last 2-4 months Last 4 to 8 months Do you use an activity sunscreen (secondary sunscreen) for outdoor activities?(Required) Y N Occasionally Pick the best response, my sunscreen use -(Required) Religious, I use sunscreen regularly I only use sunscreen when I am outside I occasionally use sunscreen I seldom or never use sunscreen PhoneThis field is for validation purposes and should be left unchanged.
