Online Adult Vitiligo Questionnaire
1. Vitiligo Online Survey
This survey is a research study designed to gather information regarding vitiligo. Vitiligo is a disorder in which color or pigment is lost in the skin. Patients who are 18 years or older who have been diagnosed with vitiligo vulgaris that has been diagnosed by a dermatologist may participate, if they desire to participate. All of the data obtained will be de-identified. This means that none of your 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
For participants in the survey/ questionnaire:
Please complete this survey to the best of your ability. If you are unable or do not wish to answer any question, please leave the response area blank. Complete only the questions which you are comfortable completing. DO NOT write your full name, address or any other personal information other than that requested..
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