Questionnaire | Pre-program Consultation | General

Project τ™

SKIN FITNESS PROGRAM

Maartje Francisco

Questionnaire | Pre-Program Consultation

Are you aware of latest research showing...

Q1: We are all just 40% Human: the remaining 60% is microbes (your Microbiome) that help protect us from ill health?

Yes No

Q2: A damaged skin microbiome has been linked to all common skin problems (e.g. eczema, dermatitis, acne etc.)?

Yes No

Q3: Most people living in the developed (Western) world already have a damaged skin microbiome?

Yes No

Q4: For long-term health, it’s crucial to have both an optimal Gut and Skin Microbiome?

Yes No

Q5: The sub-optimal skin microbiome found in Western societies is thought to be a key contributor to the steep rise in skin allergies.

Yes No

Q6: Your Skin Microbiome is probably the missing piece of the puzzle to achieve lasting Whole Body Health?

Yes No

Q7: For example, a damaged skin microbiome is now thought to play an important role in the development of food allergies, asthma, cardiovascular diseases, Parkinson's, and many more?

Yes No

Q8: Just like your gut, it is now possible to repair a sub-optimal skin microbiome too?

Yes No

Q9: Skin issues can signal that underlying health is sub-optimal too?

Yes No

THE HUMAN BODY: one Interlinked System.

Q1: Do you currently have any of the following skin types (these could be indicative of a damaged/sub-optimal microbiome)?

Q2: Does your skin condition worsen/appear in certain conditions?

Yes No

If you answered ‘Yes’, what conditions affect your skin (e.g. cold weather, illness, particular time of the month, etc)?

Q3: Have you always had this skin type?

Yes No

If you answered ‘No’, when did this start (eg. when you were a child, a teenager, or started work, etc)?

SKIN HEALTH

Q1: Do you currently have any skin problems?

- Please list all of your symptoms, followed by a severity score out of 10?

Where 10 is unbearable and 0 is non-existent. (E.g. red, inflamed skin: 6; acne pustules: 4)

Q2: Lifestyle (E.g. do you exercise and have you had any major changes recently etc)?

Q3: Which cosmetics/skincare/personal care products do you currently use?
(Please write in order of most frequently used to least frequently used)

Name

Surname

Email

How old are you now?

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Project τ™

SKIN FITNESS PROGRAM

Maartje Francisco

Questionnaire | Pre-Program Consultation

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