Skip to content
Pediatric Chronic Eczema Study Survey
Please complete this short survey to see if your child qualifies to participate in this study.
1.
Please leave your name, phone number, and email for us to contact you should you qualify for this trial.
Name:
Phone #:
Email:
2.
Is your child between 6 and 11 years old?
Yes
No
3.
Does your child have a diagnosis of chronic atopic dermatitis, or chronic eczema?
Yes
No
4.
Does your child weigh at least 22 pounds?
Yes
No
5.
If your child uses topical corticosteroids like hydrocortisone cream, are you willing to not use them while participating in the study?
Yes
No
6.
Has your child had two or more episodes of shingles?
Yes
No
I'm not sure
7.
Have you tried eczema/atopic dermatitis treatments in the past that have not worked for your child?
Yes
No