$150 Online Opinion Study

Question Title

* 1. Contact Info

Name

Phone

E-Mail

State

Gender

Age

Question Title

* 2. Have you or a child that you care for been diagnosed by a healthcare professional with any of the following?

	I have been diagnosed	A child i care for 5 or under has been diagnosed	A child i care for 6-17 or under has been diagnosed	A child i care for 18+ has been diagnosed	No one has been diagnosed
Allergies	Allergies I have been diagnosed	Allergies A child i care for 5 or under has been diagnosed	Allergies A child i care for 6-17 or under has been diagnosed	Allergies A child i care for 18+ has been diagnosed	Allergies No one has been diagnosed
Asthma	Asthma I have been diagnosed	Asthma A child i care for 5 or under has been diagnosed	Asthma A child i care for 6-17 or under has been diagnosed	Asthma A child i care for 18+ has been diagnosed	Asthma No one has been diagnosed
Atopic Dermatitis	Atopic Dermatitis I have been diagnosed	Atopic Dermatitis A child i care for 5 or under has been diagnosed	Atopic Dermatitis A child i care for 6-17 or under has been diagnosed	Atopic Dermatitis A child i care for 18+ has been diagnosed	Atopic Dermatitis No one has been diagnosed
Eczema	Eczema I have been diagnosed	Eczema A child i care for 5 or under has been diagnosed	Eczema A child i care for 6-17 or under has been diagnosed	Eczema A child i care for 18+ has been diagnosed	Eczema No one has been diagnosed
Eosinophilic esophagitis (EoE)	Eosinophilic esophagitis (EoE) I have been diagnosed	Eosinophilic esophagitis (EoE) A child i care for 5 or under has been diagnosed	Eosinophilic esophagitis (EoE) A child i care for 6-17 or under has been diagnosed	Eosinophilic esophagitis (EoE) A child i care for 18+ has been diagnosed	Eosinophilic esophagitis (EoE) No one has been diagnosed
Allergic sinusitis	Allergic sinusitis I have been diagnosed	Allergic sinusitis A child i care for 5 or under has been diagnosed	Allergic sinusitis A child i care for 6-17 or under has been diagnosed	Allergic sinusitis A child i care for 18+ has been diagnosed	Allergic sinusitis No one has been diagnosed
Chronic rhinosinusitis with nasal polyps (CRSwNP)	Chronic rhinosinusitis with nasal polyps (CRSwNP) I have been diagnosed	Chronic rhinosinusitis with nasal polyps (CRSwNP) A child i care for 5 or under has been diagnosed	Chronic rhinosinusitis with nasal polyps (CRSwNP) A child i care for 6-17 or under has been diagnosed	Chronic rhinosinusitis with nasal polyps (CRSwNP) A child i care for 18+ has been diagnosed	Chronic rhinosinusitis with nasal polyps (CRSwNP) No one has been diagnosed
Chronic Spontaneous Urticaria	Chronic Spontaneous Urticaria I have been diagnosed	Chronic Spontaneous Urticaria A child i care for 5 or under has been diagnosed	Chronic Spontaneous Urticaria A child i care for 6-17 or under has been diagnosed	Chronic Spontaneous Urticaria A child i care for 18+ has been diagnosed	Chronic Spontaneous Urticaria No one has been diagnosed
High blood pressure	High blood pressure I have been diagnosed	High blood pressure A child i care for 5 or under has been diagnosed	High blood pressure A child i care for 6-17 or under has been diagnosed	High blood pressure A child i care for 18+ has been diagnosed	High blood pressure No one has been diagnosed
Migraine	Migraine I have been diagnosed	Migraine A child i care for 5 or under has been diagnosed	Migraine A child i care for 6-17 or under has been diagnosed	Migraine A child i care for 18+ has been diagnosed	Migraine No one has been diagnosed
Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin)	Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin) I have been diagnosed	Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin) A child i care for 5 or under has been diagnosed	Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin) A child i care for 6-17 or under has been diagnosed	Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin) A child i care for 18+ has been diagnosed	Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin) No one has been diagnosed
Psoriasis	Psoriasis I have been diagnosed	Psoriasis A child i care for 5 or under has been diagnosed	Psoriasis A child i care for 6-17 or under has been diagnosed	Psoriasis A child i care for 18+ has been diagnosed	Psoriasis No one has been diagnosed
None of the above	None of the above I have been diagnosed	None of the above A child i care for 5 or under has been diagnosed	None of the above A child i care for 6-17 or under has been diagnosed	None of the above A child i care for 18+ has been diagnosed	None of the above No one has been diagnosed