Acne Study

Got Acne? You may qualify for a research study.

Below is a pre-screening survey to help us determine your qualification in one of our studies. You may stop the survey at anytime. All information provided is confidential.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Phone Number:

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* 4. Email:

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* 5. If female, are you pregnant or planning a pregnancy or nursing?

Yes

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* 6. How would you rate the severity of your acne?

Mild (whiteheads and blackheads, few pus filled pimples or small lumps)

Moderate (more whiteheads & blackheads, more pus and pimples, may have some cysts)

Severe (many whiteheads, blackheads, pus filled spots and fluid filled boils)

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* 7. On average, how many acne lesions (red or raised pimples) do you have on your face?

1-15

16-30

30+

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* 8. How many blackheads and/or whiteheads do you have on your face?

0-10

10-20

20+

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* 9. Which therapies are you currently using for your acne?

Topical Medications

Hormonal Therapy (such as Birth Control)

Accutane

Oral Antibiotic

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* 10. Have you participated in another clinical research study in the past 30 days?

Yes