Exit Acne? Get in a Study - PreScreen Survey In order to determine if you pre-qualify for this acne research study, we will ask you a few questions about your acne and what you may have tried to deal with it. You may stop answering at any time and do not need to answer any questions that make you feel uncomfortable. All information you provide will be kept confidential. Question Title * 1. Please provide: Name: Address: City/Town: State: ZIP: Email Address: Phone Number: Question Title * 2. If female, are you pregnant or planning a pregnancy or nursing? Yes No N/A - Male Question Title * 3. 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) Question Title * 4. On average, how many acne lesions (pimples) do you have on your face on a given day? 1-15 16-30 Greater than 30 Question Title * 5. Have you tried oral antibiotics for acne? Yes No Question Title * 6. Which therapies are you currently using for your acne? Accutane Hormonal therapies (such as oral contraceptives) Oral antibiotic Topical treatment Question Title * 7. Have you participated in another clinical research study in the past two months? Yes No Question Title * 8. How did you hear about this acne website (www.usacnestudy.com)? Facebook Google ad Instagram Craigslist Radio Television Search engine Other (please specify) Thank you for your answers. We will review your information and contact you if you are identified as a potential eligible candidate for this study. Done