Survey on Dining Out with Rosacea

Please fill out the following survey about rosacea and dining out. Results will be reported in the National Rosacea Society's newsletter and on rosacea.org.

1.Have you altered your diet to avoid rosacea flare-ups?

Yes

Somewhat

2.What do you do to avoid triggers when dining outside your home? (Check all that apply.)

Stick with familiar restaurants

Research new restaurants online before going

Call the restaurant for more information about dishes, ingredients, etc.

Other (please specify)

3.Do any of the following cuisines cause rosacea flare-ups for you? (Check all that apply.)

American

Chinese

French

German

Indian

Italian

Japanese

Mexican

Thai

Other (please specify)

4.How do you avoid potential dietary triggers? (Check all that apply.)

Sticking to certain dishes

Asking about ingredients and preparation

Requesting ingredients be left out or substituted

Choosing warm or cold dishes over hot ones

Other (please specify)

5.When you eat at friends or family’s homes, how do you avoid triggers?

Friends/family are aware of my triggers and provide substitute dishes

Friends/family are unaware of my triggers, so I watch what I’m eating

I bring my own food to parties and other events

Other (please specify)

6.Are you...

Male

Female

Non-binary/other

Prefer not to answer

7.Are you...

Under 30

30-39

40-49

50-59

60-69

70 or older

Prefer not to answer

8.Comment:

9.Would you like to receive the latest information on rosacea? Join the NRS mailing list by providing your contact information below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

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