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$150 Online Opinion Study
*
1.
Contact Info
(Required.)
Name
Phone
E-Mail
State
Gender
Age
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
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
Asthma
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
Atopic Dermatitis
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
Eczema
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
Eosinophilic esophagitis (EoE)
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
Allergic sinusitis
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
Chronic rhinosinusitis with nasal polyps (CRSwNP)
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
Chronic Spontaneous Urticaria
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
High blood pressure
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
Migraine
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
Prurigo / Nodular Prurigo/ Prurigo Nodularis (PN)- hard, itchy lumps (nodules) on your skin)
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
Psoriasis
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
None of the above
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