1. Have you ever had skin cancer?
   Yes    No
2. Have any members of your immediate family (mother, father and siblings) ever been diagnosed with skin cancer?
   Yes    No
3. Do you have blond or red hair?
   Yes    No
4. Do you have blue or green eyes?
   Yes    No
5. Do you have a lot of freckles?
   Yes    No
6. If you are not wearing a sunscreen, does your skin begin to burn after being in the sun for 15 to 20 minutes?
   Yes    No
7. Do you have an outdoor occupation?
   Yes    No
8. Do you participate in outdoor sports or recreational activities?
   Yes    No
9. Do you live in a high-altitude area (8,500 feet or more above sea level)?
   Yes    No
10. Did you have multiple blistering sunburns before age 18?
    Yes    No
11. Did you grow up in a sunny climate?
    Yes    No
12. Do you fail to regularly use sunscreens with an SPF (sun-protection factor) of at least 15?
    Yes    No
13. Do you have an irregular mole or a mole larger than 1/4 inch in diameter?
    Yes    No
14. Do you have numerous moles on your skin?
    Yes    No

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