Fitzpatrick Questionnaire
What color are your eyes?
0- Light blue, gray, green
1- Blue, gray, or green
2- Blue
3- Dark brown
4- Brownish black
What is your natural hair color?
0- Sandy red
1- Blonde
2- Chestnut/dark blonde
3- Dark brown
4- Black
What is your skin color (unexposed areas)?
0- Reddish
1- Very pale
2- Pale w/ a beige tint
3- Light brown
4- Dark brown
Do you have freckles on unexposed areas?
0- Many
1- Several
2- Few
3- Incidental
4- None
What happens when you stay too long in the sun?
0- Painful, redness, blistering, peeling
1- Blistering followed by peeling
2- Burns sometimes followed by peeling
3- Rarely burn
4- Never burn
To what degree do you turn brown?
0- Hardly or to at all
1- Light color tan
2- Reasonable tan
3- Tan very easily
4- Turn dark brown quickly
Do you turn brown after several hours of sun exposure?
0- Never
1- Seldom
2- Sometimes
3- Often
4- Always
How does your face react to the sun?
0- Very sensitive
1- Sensitive
2- Normal
3- Very resistant
4- Never had a problem
When did you last expose your body to the sun (or artificial sunlamp/self tanner/spray tan)?
1-More than three months ago
2- 2-3 months ago
3- 1-2 months ago
4- Less than a month ago
5- Less than 2 weeks ago
Do you expose the area to be treated to the sun?
1-Never
2-Hardly ever
3-Sometimes
4-Often
5-Always
FITZPATRICK SCALE QUIZ SCORE
0-7 = Type I
8-16 = Type II
17-25 = Type III
25-30 = Type IV
Over 30 = Type V-VI
Name
First Name
Last Name
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