Questionnaire | Pre-program Consultation | General

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

Yes No

Q6: 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

Q7: Just like your gut, it is now possible to repair a sub-optimal skin microbiome too?

Yes No

Q8: Skin issues can signal that underlying health is sub-optimal too?

Yes No

Skin is often an early indicator of an underlying health problem.

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

Q2: Do these worsen/appear in certain conditions?

Yes No

Q3: If you answered ‘Yes’, what conditions affect your skin (e.g. cold weather, illness, particular time of the month, etc)?

Q4: Have you always had this type of skin?

Yes No

Q5: If you answered ‘No’, when did this start (eg. when you were a child, a teenager, or started work, etc)?

The sub-optimal skin microbiome found in Western societies is almost certainly a key contributor to the steep rise in skin allergies.

Q1: Do you CURRENTLY have any specific, diagnosed skin health problems from the list below?

Q2: If you are currently experiencing any of these skin problems, when did they first start (eg. 2 years ago, etc)?

Q3: Where is your skin problem mainly located?

Q4: Have you been trying to manage this condition (eg. cosmetics, washing, creams, prescription medicines etc.)?

Q5: Please list each symptom you are experiencing due to your skin problems at the moment. Please also rate the severity of each symptom selected on a scale of 0-10 (10 being most severe) by putting the number in the relevant box.

Q6: Have you suffered with any specific skin health problems in the past?

Q7: How long ago did you have them? Can you expand on how long they lasted and other details.

Q8: Are you aware of any lifestyle change that may have contributed?

Q9: Please give details of *any* health issues you have which could compromise your immune system?

Q10: Please give details of *any* drugs or medicines you are currently taking. Common ones are

Antibiotics Topical Steroids. Other (please specify below):

How old are you now?

Q2: Please list each symptom you are experiencing due to your skin at the moment.

(eg. sensitive skin, red and inflamed skin, pustules, whiteheads, deep itching, flaking skin, infections, split skin, oozing sores, bumpy skin etc.)

Q3: From 0-10 (10 being awful and 1 being non-existent) please rate the severity of each symptom selected in Q1.

Q4: Please give details of *any* health problems you have which could compromise your immune system.

(eg. food/other allergies, sensitivities to certain substances, fungal overgrowth, gut problems, diseases such as diabetes, high blood pressure, heart disease, pregnancy, weight issues etc...).

Q5: Please give details of *any* drugs you are taking currently. Common ones are antibiotics and topical steroids.

Project τ™

SKIN FITNESS PROGRAM

Dr. Tetiana Martynovska

Questionnaire | Pre-Program Consultation

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