Question 1 of 11
Please choose from the following:
Question 2 of 11
How long ago were you diagnosed?
Question 3 of 11
How long ago was your last in-person visit with a provider for this condition?
Question 4 of 11
What part of your body is affected? Select all that apply.
Question 5 of 11
Do you currently have any of the following?
Question 6 of 11
Have you had problems with any rosacea treatments (e.g. side effects or ineffective treatment)?
Question 7 of 11
Do you have any other health conditions?
Question 8 of 11
Are you currently taking any regular medications?
Question 9 of 11
Do you have any allergies?
Question 10 of 11
Is there any further information you would like to provide?
Question 11 of 11
Would you like to have a video or telephone consultation?