Question 1/19

Do you or someone in your household suffer from Acne?

Question 2/19

How would you describe your acne?

Occasional
Moderate
Mild
Severe

Question 3/19

Where does your acne appear?

Question 4/19

Do you wash your skin with a mild soap like Dove or Neutrogena?

Question 5/19

What do you think contributes to your acne?

Question 6/19

If yes, have you taken a prescription to treat your acne?

Question 7/19

What type of acne do you have?

Question 8/19

How do you treat your acne?

Question 10/19

Are you currently satisfied with your treatment?

Question 11/19

Please explain why are you dissatisfied with your current treatment.

Question 12/19

Are you interested in changing your treatment?

Question 13/19

What treatment(s) are you interested in switching to

Question 14/19

Does rosacea occur in your family?

Question 15/19

If yes, have you been diagnosed with rosacea?

Question 16/19

Do you currently see a dermatologist?

Yes
No
Planning on making an appointment soon.

Question 17/19

Do you have children who suffer from acne?

Question 18/19

What is the name of your provider?

Question 19/19

lease select the current medical coverage you have