This survey is a research study designed to gather information regarding childhood vitiligo. Vitiligo is a disorder in which color or pigment is lost in the skin. Parents of children (age 17 years or less) with vitiligo vulgaris that has been diagnosed by a dermatologist can participate. All of the data obtained will be de-identified. This means that none of your child’s personal information will be shared, outside of grouped information regarding all the survey responses.
Study data will be collated and responses will be stored at the Department of Dermatology, St. Luke’s-Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11D, NY, NY 10025.
If you have any questions regarding this study, please contact Dr. Nanette Silverberg at email@example.com or call (212) 523-3888.
Please complete this survey to the best of your ability. If you do not wish to answer or are unable to answer any question, please leave the response area blank. DO NOT write your full name, address or any other personal information other than that requested.