PARALLEL

1
2

Hello!

In this questionnaire, we'll be asking you about your skin (as you believe it to be today), as well as your lifestyle and preferences. These answers will help us understand if you are a good fit for our skin microbiome test(s), personalized products, and studies in the future.

Our microbiome test in the future will provide you with your unique microbial sequencing results, as well as recommendations for precision skincare and personalized prescriptions.
3
Enter Your Full Name* This field is required.
First Name
Last Name
4
What is your birthdate?* This field is required.
Date
Month
Day
Year
5
Gender* This field is required.
Male
Female
Other
6
What is your ethnicity?* This field is required.
White/Caucasian
Asian
Latino
Black
Native American
Middle Eastern
Two or More Races
Other
7
What is your email address?* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? orReceiving the email may take a few minutes, thank you for your patience!
8
What is your phone number?* This field is required.For study purposes, please provide a number where you can receive texts.
Area Code
Phone Number
9
What is your full mailing address?* This field is required.Please provide a street address (no P.O. boxes please). This is where we will send your microbiome test kit.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
If you live in a city that's different from your mailing address, please tell us your city/zip code where you reside (optional).Where you live affects your skin microbiome!
11
How did you hear about Parallel?* This field is required.
Friend/family referral
Newsletter or referral from doctor/dermatologist
Facebook/Instagram ad
Organic social post (FB, IG, Linkedin, Twitter)
Google search
Other
12
Now, let's find out about your skin. On a scale of 1-10, how healthy does your skin feel?* This field is required.1 being VERY UNHEALTHY (far left), 5 is NOT SURE (center), and 10 is VERY HEALTHY (far right). Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
13
Where is your face (facial skin) on the dry/oily spectrum?* This field is required.1 being VERY DRY (far left), 5 is COMBINATION (center), and 10 is VERY OILY (far right) Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
14
How often do you experience breakouts + blemishes?* This field is required.1 being NEVER (far left), 5 is OCCASIONALLY (center), and 10 is CONSTANT (far right) Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
15
How often do you experience itchiness/redness/sensitivity?* This field is required.1 being NEVER (far left), 5 is OCCASIONALLY (center), and 10 is CONSTANT (far right) Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
16
To the best of your knowledge, do you experience any of the following conditions?* This field is required.Check all that apply
Cystic Acne
Fungal Acne
Hormonal Acne
Eczema
Rosacea
Redness and Hypersensitivity
Consistent Skin Allergies
Melasma
Hidradenitis Suppurativa
None of these
Fine Lines and Wrinkles
17
Where do you experience skin issues?* This field is required.
Forehead
Cheeks
Nose
Chin / Jawline
Scalp
Back
Chest
Armpits
Other
I generally don't experience skin issues
18
Please use this space to share any unique skin issues you might have
19
In this section, we want to understand your lifestyle. How stressed do you feel on a daily basis, in general?* This field is required.1 being NOT STRESSED AT ALL (far left), 5 is FAIRLY STRESSED (center), and 10 is EXTREMELY STRESSED (far right) Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
20
How often do you eat home-cooked, unprocessed foods?* This field is required.1 being NEVER (far left), 5 is 3-4 DAYS/WEEK (center), and 10 is EVERY DAY (far right) Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
21
How much water do you drink on a daily basis?* This field is required.1 being NONE (far left), 5 is 3-4 CUPS/DAY (center), and 10 is MORE THAN 8 CUPS/DAY (far right) Note: the default answer is "6". To change, move the slider left or right.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
22
On average, how much sleep do you get every night?* This field is required.
> 8 hours/night
Between 7-8 hours/night
Between 6-7 hours/night
Between 5-6 hours/night
Between 4-5 hours/night
Less than 4 hours/night
23
Who lives in your household?* This field is required.Check all that apply
I live by myself
I live with my partner/spouse/friend
I live with a group of friends
I live with my parents
I have 1 child
I have more than 1 child
I have 1 or more pets
24
Are you a smoker, or live in an environment where you inhale smoke second-hand?* This field is required.
YESNO
25
How much alcohol do you drink on a weekly basis?* This field is required.
I don't drink
I drink once every few weeks, if that
1-2 drinks/week
3-4 drinks/week
More than 5x/week
26
How many makeup products do you use a day?* This field is required.i.e. mascara, foundation, eyeliner, powder, etc.
I don't use any makeup products
1-3 products
4-6 products
More than 6 products
27
How often do you wear deodorant?* This field is required.
Never
Rarely
A few times a week
Every day
28
How many skincare products do you use a day?* This field is required.i.e. cleanser, moisturiser, serums, sunscreen, etc.
I don't use any skincare products
1-3 products
4-6 products
More than 6 products
29
How much do you normally spend on skincare products (per month)?* This field is required.
Over $500/mo
$250-500/mo
$100-250/mo
$50-100/mo
Less than $50/mo
30
How often do you try new skincare products?* This field is required.
Rarely
A few times a year
Once a month
A few times a month
Constantly
31
When you have skin issues, whose advice do you seek and trust first and foremost?* This field is required.Make between 1 and 2 choices
Friends/Family
Aesthetician
Dermatologist
Instagram Influencer
In-Stores Sales Staff
Independent Research (Google Search, Reddit, Scientific Journals)
32
What prescription skincare (or non-skincare) medications, including antibiotics, are you currently taking?If not taking any prescriptions, write "N/A"
33
Do you take any of the following dietary supplements?* This field is required.Check all that apply
Multivitamin
Collagen (Powder or Capsule)
Other Skin Supplement
Gut Probiotic
Vitamin D
Zinc
Other
I don't take supplements
34
Are you:
Pre-menopausal
Taking fertility medications
Pregnant
Menopausal
Post-menopausal
35
What are the skincare products (up to 3) you believe to be most useful for you personally and why?
36
Almost done! What are the skincare ingredients (up to 3) you believe to be most useful for you personally and why?
37
Thank you! We appreciate you taking the time to share about yourself and your skin health journey. Would you be open to being interviewed about your current skincare routine and skin goals with one of our co-founders?* This field is required.
YESNO
38
Please verify that you are human* This field is required.
39
We appreciate you! If you have any questions, feel free to reach out to us at hello@parallelhealth.io.
40
Unique ID
41
42
utm_source
43
utm_medium
44
utm_campaign
45
utm_content
46
utm_term
47
fbclid
Should be Empty:

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.