Survey on Rosacea Flare-ups

Please fill out the following survey about your personal experience with rosacea flare-ups. Results will be reported in the National Rosacea Society's newsletter and on rosacea.org.

Question Title

* 1. Approximately how frequently do you experience a rosacea flare-up — the reappearance or increase in intensity of rosacea symptoms?

Every few days

Once a week

Once a month

Every few months

Once a year

Other (please specify)

Question Title

* 2. How intense are your rosacea flare-ups?

Mild

Moderate

Severe

Question Title

* 3. How long do your rosacea flare-ups usually last?

Less than a day

More than a day

More than a week

More than a month

Several months

Other (please specify)

Question Title

* 4. Has medication been effective in controlling your rosacea flare-ups?

Yes

Somewhat

Question Title

* 5. Has avoidance of factors that aggravate your rosacea been effective in controlling your flare-ups?

Yes

Somewhat

Question Title

* 6. How long ago were you diagnosed?

Less than a year

1-5 years

6-10 years

More than 10 years

Question Title

* 7. Are you...

Male

Female

Non-binary/other

Prefer not to answer

Question Title

* 8. Are you...

Under 30

30-39

40-49

50-59

60-69

70 or older

Prefer not to answer

Question Title

* 9. Comment:

Question Title

* 10. Would you like to receive the latest information on rosacea? Join the NRS mailing list by providing your contact information below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address