BDD Questionnaire

This is a screening questionnaire for aesthetic procedures as required by government guidelines.

1) Have you been very concerned about some particular aspect of your physial appreance *

2) Have you had concerns about your body in any way (eg -excessive body odour ,sweating) and consulted specialist such as plastic surgeon/dermatologist/specialist *

3) Have you considered been misformed or misshapen in some way (eg - hair,skin,body build,nose) *

4) Have you ever been excessively concerned that something is wrong with your appreance or body function when a doctor said it s normal *

5)Do you spend excessive time worrying about this defect and covering the defect in your appearance or body function *

Fitzpatrick Scale by ARPANSA

Genetic (physical traits)

What is your natural eye color? *

Light blue or green, grey (0)
Blue, green, grey (1)
Dark blue or green, light brown (hazel) (2)
Dark Brown (3)
Brown / Black (4)

What is your natural skin color (non-exposed areas)? *

pink (0)
Very pale (1)
Light brown or olive (2)
Brown (3)
dark brown (4)

What is your hair color (naturally and before ageing) ? *

Red / Auburn / Light Blonde (0)
Blonde (1)
Chestnut or dark blonde (2)
Dark Brown (3)
Black (4)

Do you have freckles on unexposed areas? *

Many (0)
Several (1)
A few (2)
Rare (3)
None (4)

Sensitivity (Reaction to sun exposure)

What happens to your skin if you stay in the sun for an extended period

Severe burns, blisterings, peel (0)
Moderate burns, blistering, peeling (1)
Sometimes burns, followed by peeling (2)
Rare burns (3)
No burns (4)

How tan/brown do you get?

Hardly or not at all (0)
Light tan (1)
Medium tan (2)
Dark tan (3)
Very Dark tan (4)

Do you turn brown after sun exposure?

Never (0)
Rarely (1)
Sometimes (2)
Often (3)
Always (4)

Is your face sensitive to the sun

Very sensitive (0)
Sensitive (1)
Mildly sensitive (2)
Resistant (3)
Very resistant (4)

Intentional sun exposure/ tanning habits

How often do you tan?

Never (0)
Rarely (1)
Sometimes (2)
Often (3)
Always (4)

When did you last expose your skin to the sun or artificial tanning sources?

More than 3 months ago (0)
In the last 2-3 months (1)
In the last 1-2 months (2)
In the last week (3)
In the last day (4)

Scoring

Add up your total score from all questions.

Fitzpatrick Skin Type

Fitzpatrick Skin Type Skin Characteristics

Total Score	Fitzpatrick Skin Type	Skin Characteristics
0–6	Type I	Always burns, never tans
7–13	Type II	Burns easily, tans minimally
14–20	Type III	Sometimes mild burn, tans uniformly
21–27	Type IV	Rarely burns, tans easily
28–34	Type V	Very rarely burns, tans very easily
35+	Type VI	Never burns, deeply pigmented

BDD Questionnaire & Fitzpatrick Scale