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* 1. First name

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* 2. Last name

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* 3. Telephone number

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* 4. Email address

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* 5. What is your gender?

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* 6. Has a doctor ever told you have eczema or atopic dermatitis?

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* 7. Do you continue to experience eczema or atopic dermatitis flare-ups from time-to-time?

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* 8. When did you last experience a flare-up?

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* 9. How frequently do you experience eczema or atopic dermatitis flare-ups

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* 10. What time of year do you experience eczema or dermatitis flare-ups?  (check all that apply)

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* 11. Where on your body do you generally experience eczema or atopic dermatitis flare-ups (check all that apply)

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* 12. If you were selected to participate in a study testing a new product, would you be willing to stop using your current product (if any) and only use the test product as directed?

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* 13. Are you available on the following dates: 
 Visit 1:  January 23, 2020 (approx 1 hr)
Visit 2:   January 28 or January 29 (only 1 day is required - approx. 2.5 hrs)
Visit 3:   February 4 or February 5 (only 1 day is required - approx. 2.5 hrs)

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