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Survey on the Physical Discomforts of Rosacea
Please fill out the following survey about your personal experience with physical discomforts of rosacea. Results will be reported in the National Rosacea Society's newsletter and on rosacea.org.
1.
Have you ever experienced physical discomfort associated with your rosacea?
All the time
Frequently
Occasionally
Never
2.
What type(s) of physical discomfort have you experienced? (Check all that apply.)
Burning
Stinging
Itching
Tightness
Tingling
Prickling
Swelling
Tenderness
Headache
Other (please specify)
3.
Where have you experienced discomfort? (Check all that apply.)
Cheeks
Nose
Chin
Forehead
Neck
Eyes
Ears
Behind ears
Scalp
Chest
Mouth
Other (please specify)
4.
Does your discomfort occur at the same time as the visible signs of rosacea?
Yes
Sometimes
No
5.
Has medical therapy improved your physical discomfort?
Yes
Somewhat
No
6.
Has medical therapy improved your visible signs of rosacea?
Yes
Somewhat
No
7.
Are you...
Male
Female
Non-binary/other
Prefer not to answer
8.
Are you...
Under 30
30-39
40-49
50-59
60-69
70 or older
Prefer not to answer
9.
Comment:
10.
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