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Nastran Skin Care

Personalized Wellness & Lifestyle Assessment

Nastran Signature Wellness Profile™

Your wellness is personal. Your care should be personal too.

This assessment is designed to help us better understand your daily lifestyle, skin, digestion, sleep, stress, nutrition, and wellness patterns.

This is a wellness assessment and does not provide a medical diagnosis or replace medical care.

Your answers go securely to our customer care team at nastrancustomercare@nastranskincare.com. Questions marked * are required; answer the rest as fully as you are comfortable.

Your contact details

Not part of the printed form — we need these to send you your personalized plan.

Section 1 — About you
Sex
Height & weight
Usual activity level
Main wellness goalsSelect up to 3.
Section 2 — Body comfort & daily response

How often does each statement apply to you? 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Almost always.

My hands or feet tend to feel cold.
I feel unusually sensitive to cold temperatures.
I often feel unusually warm or overheated.
I sweat easily, even when the environment is not very warm.
My face tends to become flushed or unusually warm.
Spicy or very hot foods tend to make me uncomfortable.
Very cold foods or drinks tend to cause digestive discomfort.
I naturally prefer warm foods and beverages.
Section 3 — Skin hydration & body fluid response

How often does each statement apply to you? 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Almost always.

My skin often feels dry or lacking moisture.
My lips or mouth often feel dry.
My hair tends to be dry, brittle, or lacking softness.
My bowel movements tend to be dry or difficult to pass.
I often notice puffiness around my eyes or face, especially in the morning.
I often feel heavy or uncomfortable after eating.
I feel that my body tends to retain fluid.
Rings, shoes, or clothing sometimes feel tighter than usual.
Section 4 — Digestive wellness

How often does each statement apply to you? 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Almost always.

I experience bloating after eating.
I experience fullness or heaviness after meals.
I experience heartburn, acid reflux, or a burning sensation.
I feel sleepy or unusually tired after eating.
I experience constipation.
I experience loose stools or diarrhea.
Certain foods consistently make my digestion worse.
My appetite changes noticeably from day to day.
I have fewer than three bowel movements per week.
Section 5 — Skin wellness

How often does each statement apply to you? 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Almost always.

Skin type
My skin becomes red easily.
My skin feels tight after cleansing.
My skin reacts easily to new products.
I currently experience active acne or breakouts.
I tend to develop breakouts around my chin, jawline, or neck.
My skin can feel oily and dehydrated at the same time.
I have pigmentation, dark spots, or uneven skin tone.
Stress noticeably affects the appearance of my skin.
I experience skin itching, burning, or irritation.
Section 6 — Hair & nail wellness

How often does each statement apply to you? 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Almost always.

I experience noticeable hair shedding.
My hair has become thinner than before.
My scalp is frequently oily, flaky, or uncomfortable.
I have noticed increased facial or body hair.
My nails are brittle, weak, or break easily.
Section 7 — Hormone-related wellness
Current menstrual or reproductive status
Has there been a meaningful change in your menstrual cycle during the past 3 months?
Has your menstrual bleeding become significantly heavier than usual?
Before your period, do you experience symptoms such as bloating, mood changes, food cravings, or breast tenderness?
Does your acne or skin condition noticeably worsen around your period?
Do you experience hot flashes or night sweats?
Have you had a significant unintentional change in weight recently?
Do you experience persistent fatigue or unusually low energy?
Section 8 — Sleep, stress & mental load

How often does each statement apply to you? 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often, 4 = Almost always.

I have difficulty falling asleep.
I wake up during the night and have difficulty returning to sleep.
I wake up feeling tired or unrefreshed.
My mind is difficult to quiet at bedtime.
I spend a lot of time thinking about the past or future.
I notice muscle tension when I am stressed.
Stress noticeably affects my skin or digestion.
I experience mental fatigue or difficulty concentrating.
Section 9 — Nutrition, movement & daily habits
How often do you do intentional physical activity?
Do you eat fruits and vegetables throughout the day?
How often do you have foods or drinks high in added sugar?
Daily water intake
Caffeine after 3 PM
Do you use a phone, tablet, computer, or TV during the hour before sleep?
Section 10 — Nicotine, alcohol & substance exposure

This section is confidential and is included only to help us personalize your wellness plan and consider safety.

Current nicotine use
Alcohol use
Have you ever used recreational or non-prescribed substances?
Are you currently receiving support to reduce or stop nicotine, alcohol, or another substance?
Additional wellness & safety information
Please tell your practitioner if any apply:Select all that apply.
Please tell your practitioner if you currently have:Select all that apply.

Thank you for sharing your information. Your responses help us create a more personalized wellness experience.

NASTRAN SKIN CARE • Personalized Care. Thoughtfully Designed.