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Atopic Dermatitis Survey
*
1.
Are you currently in clinical practice?
(Required.)
Yes
No
*
2.
How many patients with uncontrolled moderate to severe atopic dermatitis do you see on a weekly basis?
(Required.)
0
1-5
6-10
11-20
≥21
*
3.
The remaining questions are regarding your patient case.
Please indicate your patient’s sex:
(Required.)
Male
Female
*
4.
Please indicate your patient’s age group:
(Required.)
0-1 years
2-11 years
12-17 years
≥18 years
*
5.
Does the patient have any of the following comorbidities? (Choose all that apply)
(Required.)
Atopic dermatitis
Food allergy
Chronic rhinosinusitis
Nasal Polyps
Anxiety
Depression
Sleep disturbance
*
6.
Please provide a detailed description of your case, including past and current medication, relevant comorbidities, known laboratory values, and clinical assessment
(Required.)
*
7.
If my case is selected for discussion, I can be contacted to provide additional HIPAA-compliant details,
if necessary
, to help elucidate the scenario for resolution by the expert faculty
(Required.)
Yes
No
*
8.
If yes, please provide your email address:
(Required.)
Current Progress,
0 of 8 answered
