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Da Ký™ Survey

Da Ký™ Skin Record

This survey helps the Claire team understand your skin and lifestyle fully before your one-to-one consultation. It takes about 8–12 minutes.

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Survey
Da Ký™

皮記: Skin Record

This survey helps the Claire team understand your skin and lifestyle fully before your one-to-one consultation. It takes about 8–12 minutes.

STEP 1 / 8
Basic information

All information is kept strictly confidential and used only for skin consultation at Claire.

Basic information 1 / 8

Basic information

Women
Men
Other
Tân Sơn Nhất: Tân Bình
Phú Mỹ Hưng: District 7

Sleep

Under 5 hours
5–6 hours
6–7 hours
7–8 hours
Over 8 hours
Very good: deep sleep, wake refreshed
Fair: sometimes wake in the night
Poor: hard to fall asleep or often wake up
Very poor: chronic insomnia
Before 22:00
22:00 – 23:00
23:00 – 00:00
00:00 – 01:00
Sau 01:00

Lifestyle & habits

Under 1 litre
1 – 1.5 litres
1.5 – 2 litres
Over 2 litres
High in sugar / starch
Lots of fried, oily food
Lots of vegetables
Daily coffee
Regular alcohol
Eat little, often skip meals
Balanced, regular meals
Air-conditioned office all day
Outdoors, lots of sun exposure
A mix of indoors and outdoors
Polluted, dusty environment
None
Quit
Occasionally
Daily

Movement & exercise

Almost never
1–2 sessions / week
3–4 sessions / week
5+ sessions / week
Yoga / Pilates
Gym / Weights
Cardio / Running
Swimming
Team sports
Light walking
Very little
Moderate
A lot
Very much

Stress level

Very low Very high
Trouble sleeping
Breakouts
Redder, more sensitive skin
Changes in eating
Headaches, fatigue
No clear effect
High work pressure
A change of living environment
Major emotional upheaval
Pregnant or postpartum
Perimenopause / menopause
A stable, normal period

Da Ký™ skin profile

The following four questions identify your skin type using the Da Ký™ classification, based on Dr Leslie Baumann's research into 16 skin types and adapted to Claire's approach to care. Please answer based on your skin when you're not using any products.

Parameter 1: Hydration & oil
Very dry, tight, may flake; clearly dehydrated, easily cracked around the mouth and eyes
Slightly dry to normal; a little tight but not uncomfortable
Oily T-zone, dry cheeks; clearly combination
Oily all over; shiny after 30–60 minutes, pores often enlarged
Parameter 2: Sensitivity
Very sensitive; easily red, burning, itchy or rashy; sometimes rosacea or eczema
Moderately sensitive; occasionally reacts to some ingredients, needs products chosen carefully
Fairly resilient; rarely irritated, most products are fine
Very resilient; hardly reacts to products or the environment
Parameter 3: Pigmentation
Heavy, persistent pigmentation; obvious marks, melasma and freckles; post-acne marks last a long time
Mild to moderate pigmentation; some marks, but they fade by themselves within a few weeks
Little pigmentation; rarely any marks, skin fairly even in tone
No pigmentation issues; even skin tone, no significant marks or melasma
Parameter 4: Ageing & elasticity
Clearly ageing; wrinkles, deep folds, sagging, a lot of lost elasticity
Beginning to age; faint wrinkles appearing, skin less elastic than before
Skin still in good shape; fairly firm, only light laughter lines
No signs of ageing yet; firm, elastic skin, no significant wrinkles

Concerns & goals

Acne / inflamed acne
Dark marks, melasma / pigmentation
Ageing / wrinkles
Dull, lacklustre skin
Enlarged pores
Oily / shiny skin
Dry / dehydrated skin
Sensitive / irritated skin
Sagging / loss of elasticity
Scars / pitted scars
None, just washing my face
Minimal, 2–3 basic steps
Moderate, 4–6 steps
Complex, 7+ steps, many actives
(leave blank if none)

Medical & aesthetic information

This information helps our doctor ensure your treatment is safe and appropriate.

01
Have you ever had a bad reaction to a skin treatment?
Have you ever had a bad skin reaction from skincare treatment?
02
Do you have a chronic skin condition?
Do you have any chronic skin conditions?
03
Have you had any aesthetic procedures?
Have you had any aesthetic procedures before?
04
Do you have allergies to medication, food or topical creams?
Have you ever had an allergic reaction to any medication, food or creams?
05
Any reaction to anaesthetics such as Novacaine / Lidocaine?
Reaction from local anesthetic such as Novacaine / Lidocaine?
06
Are you currently undergoing any medical treatment?
Are you currently undergoing any medical treatment?
07
Are you pregnant or breastfeeding?
Are you pregnant or nursing?
Consent

We keep your information only for your treatment at our clinic and never share it with any third party. You may ask to view and keep a copy of your treatment results.

We will keep a record of the services and may take photos of treatments we provide you. We will not disclose or use your information or display your photos without your permission.

Thank you.

We've received your Da Ký™ record. The Claire team will contact you via Zalo within 24 hours to arrange your consultation.

care, quietly.