Thank you for your interest in our upcoming project for individuals who suffer from different skin conditions. We want to include your opinions. First, please fill out the following preliminary questions. Someone will be in contact with you shortly after completing. 

If you have any questions please contact Marcia at or at 224-475-8771

Thank you! 

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* 1. Please fill out the following contact information

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* 2. Please select one of the following that fits your relationship with Vitiligo:

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