SKIN SURVEY

FIRST UP... WHICH CLINIC ARE YOU GETTING CHECKED AT?(Required)

None... I'm just visiting and happy to take part

Bondi Beach with La Roche-Posay

Chemist Warehouse (Chadstone) with La Roche-Posay

URBN Surf (Melbourne) with La Roche-Posay

David Jones (Botannica)

South 32

SPA Alliance

North East Link

F1 (Melbourne) with La Roche-Posay

Name(Required)

First Name Last Name

Email(Required)

Phone number(Required)

✓ Valid number ✕ Invalid number

Date of birth(Required)

Day

Month

Year

Your company / workplace:

When was your last skin check?

If you've never been checked (or can't remember) just leave it blank

Day

Month

Year

Your usual GP / doctor's name:

Name of their clinic:

Their clinic's location:

Suburb State

YOUR SKIN CHECK HISTORY:

Have you ever had a skin check before?(Required)

Yes

Why have you never been checked before?

You can select more than one!

Never even thought about it

Been on my 'to do' list but never got around to it

I think it's normally too expensive

The wait times at my local clinic are too long

How often do you get checked?

Every three months

Every six months

Every year

Every few years

More than five years ago

Only been checked once

When you get checked, is it mostly with…

General Practitioner

Nurse Dermoscopist

Skin Cancer Clinic

Dermatologist

If it wasn't for this initiative, do you think you'd get checked this year?(Required)

No, probably not

Yes I would have booked one anyway

What made you get checked with us?(Required)

You can select more than one!

It's FREE!

Ease & convenience

I was walking past and saw it

My company organised it!

My friends / family encouraged me

I read about it in an email

I saw it on social media

How would you rate our service?

5 being exceptional and 1 being unsatisfactory

What did you like?

What could we improve?

YOUR SKIN CANCER RISK:

SKIN TYPE:(Required)

Pale white

Fair

Darker white

Brown

Dark brown / black

EYE COLOUR:(Required)

Green

Hazel

Blue

Brown

PROTECTION: When you go out in the sun without sun screen...(Required)

I always burn and do not tan

I burn easily and tans poorly

I tan after an initial burn

I burn minimally and tan easily

I rarely burn and get a dark easily

I never burn and always tan darkly

SUN DAMAGE: How many times have you been severely sunburnt?(Required)

We're talking blistering, red, peeling - can't sleep sunburn 😭 A recent study found that people who've had at least five severe sunburns are 68% more at risk of developing an SCC or BCC skin cancer (we'll talk about those letters more later). Annnnd, are 80% more at risk of melanoma (the most dangerous form of skin cancer).

Ten or more

5 < 9

1 < 4

Never

TIME IN OZ: How long have you lived in Australia?(Required)

We've got some pretty brutal sun down here...

Just visiting

Less than a year

1 - 5 years

5 - 10 years

10 - 20 years

20 + years

WHERE ABOUTS?(Required)

Different parts of the country have different risk factors.

Regional / remote

Metropolitan

ETHNICITY: What's your ethnic background?(Required)

This all boils down to melanin. A special pigmented property of your skin which can scatter and absorb Ultra Violet radiation from the sun. While the question might seem simplistic, it's actually fairly accurate. People indigenous to Africa, Australia, Asia, the Pacific Island and the Americas have generally evolved closer to the equator and lived with more sun. Providing more melanin/ protection from UV damage. This doesn't mean if you have darker skin you can't get skin cancer. It just tweaks your risk profile a bit.

Europe, UK, Scandinavia, Russia & Northern Asia

Central Asia

Indigenous Australia, Pacific Islands, Africa or South America

GENDER: Do you identify as...(Required)

The reason we ask is that 69% of skin cancer deaths in Australia are men. This is most likely due to a combination of factors like sun-safety (or lack thereof), outdoor occupations and lower skin check rates compared to women- who generally see their GP a lot more than most Aussie blokes. In saying that... women tend to sun-bake more than men, which also super dangerous. Just remember, there's nothing healthy about a tan and look after each other out there!

Male

Female

Non-binary

AGE: What's your age bracket?(Required)

60+

40 to 59

Less than 39

FRECKLES: As a teenager, how many moles / freckles did you have?(Required)

The cute little spots can be an indicator of sun damage in your earlier years.

Lots

A few

None

Has anyone in your immediate family had a skin cancer before?(Required)

Skin Cancer can be genetic, so it's always good to know if your family has done battle with it to help you be more vigilant.

Yes

Was it melanoma?(Required)

Melanoma is the most dangerous form of skin cancer - and if left unchecked - can penetrate your skin and enter your bloodstream, causing all kinds of nasty complications. Studies have shown that over 10% of melanoma is hereditary. Which means, it can be passed down from generation to generation.

Yes

Not sure

Have you ever had skin cancer before?(Required)

This includes Solar & Actinic Keratosis, Squamous Cell Carcinoma, Basal Cell Carcinoma & Melanoma.

Yes

Was your skin cancer melanoma?(Required)

Yes

TOP WORK!

You'll get your results after hitting the button below:

This field is for validation purposes and should be left unchanged.

SKIN CANCER SURVEY

YOUR SKIN CHECK HISTORY:

YOUR SKIN CANCER RISK:

TOP WORK!

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