Survey on Rosacea and Mental Health

Please fill out the following survey about rosacea and mental health. Results will be reported in the National Rosacea Society's newsletter and on rosacea.org.

Question Title

* 1. Has rosacea impacted your mental health?

Never

Occasionally

Frequently

All the time

Question Title

* 2. Which of the following feelings have you experienced as a result of having rosacea?

Frustration

Embarrassment

Anger

Isolation

Depression

Anxiety

Helplessness

Other (describe)

Question Title

* 3. What tools or techniques have you employed to improve your rosacea-related mental health?

Talk to friends/family

Talk to therapist

Meditation

Journaling/diary

Social media forums/groups

Nothing

Other (please describe)

Question Title

* 4. Have these tools and techniques improved your mental well-being?

Yes

Somewhat

Question Title

* 5. Has effective rosacea therapy improved your mental well-being?

Yes

Somewhat

Question Title

* 6. Are you...

Male

Female

Non-binary/other

Prefer not to answer

Question Title

* 7. Are you...

Under 30

30-39

40-49

50-59

60-69

70 or older

Prefer not to answer

Question Title

* 8. Comment:

Question Title

* 9. 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