AroraMD Skin Confidence Report

Please complete this appraisal 4-6 weeks after your treatment.

Microneedling Treatment Type

Full Name (Optional)

Email Address (Required)

Current Age (Required)

Total Sessions Completed

0 = Worst Possible | 10 = Best Possible

Q1. My Skin Texture/Smoothness BEFORE treatment:

0 (Worst) 5 10 (Best)

Q2. My Skin Texture/Smoothness TODAY:

0 (Worst) 5 10 (Best)

Q3. My Skin Radiance/Glow BEFORE treatment:

0 (Worst) 5 10 (Best)

Q4. My Skin Radiance/Glow TODAY:

0 (Worst) 5 10 (Best)

0 = Strongly Disagree | 10 = Strongly Agree

Q5. I look noticeably more **refreshed** and **rejuvenated** since the treatment.

0 (Disagree) 5 10 (Agree)

Q6. The results were worth the **cost** and **downtime**.

0 (Disagree) 5 10 (Agree)

Q7. I feel more confident in my appearance as a result of the treatment.

0 (Disagree) 5 10 (Agree)

Q8. I am likely to recommend the Vampire Facial to a friend or family member.

0 (Disagree) 5 10 (Agree)

Robin Arora MD's Proprietary Skin Assessment System (ARORA-FQ)