Psoriasis sufferer's survey

Psoriasis survey Below is our online medical research survey for psoriasis sufferers. Please note, even if you do not personally suffer from psoriasis, it would be extremely beneficial to still complete our survey. Not only are we trying to see who is more likely to suffer from psoriasis, but also people who are least likely. Please take a moment to complete our survey, it will assist our research and product development. All information is strictly confidential, and all information is optional, meaning if you are not comfortable with a question, please enter N/A (rather than just leaving it blank as we may think that you missed a question.) We would like to learn from you and also provide you accurate and appropriate information of interest. We will consider your answers and update our web page accordingly. The survey takes approximately 8-10 minutes to complete. We have had many thousands of surveys completed and will soon publish our results. please provide a valid email address and we will send you our survey results so far. This survey is governed by our privacy policy.

SPAMMERS: Please note, it is pointless submitting your web page to this form, the results are confidential and not posted anywhere.

First name:		Last name:
Company:		Web page:
Email:		phone (H):
phone (W):		Cell phone:
Fax:

Address #1:		Address #2:
Address #3:		Address #4:
City:		State:
Zipcode:		Country:

Years effected
Your sex
Your age, or age of person suffering? please type answer
Suffered from birth?
Does your psoriasis come and go?
Do you know what "triggers" your condition?
If yes, please provide details
Did any of your parents suffer from psoriasis?
Did any of your Grand parents suffer from psoriasis?
Did you parents suffer from arthritis?
Did you Grand parents suffer from arthritis?
How dark would you say your skin is?
What colour would you say your hair is?
How many hours per week do you work?
Do you have high blood pressure?
Do you have high cholesterol?
Sensitive to food additives such as MSG and colouring?
Do you have liver or kidney problems?
How much water do you drink every day?
Are you a regular caffeinated coffee drinker?
Do you drink a lot of milk?
Are you lactose intolerant (allergic to milk fats?)
Do you eat a lot of junk foods (fatty, oily, salty foods?)
Do you suffer from heart burn or digestion problems
Do you have dandruff?
Do you eat 3 regular meals a day?
For your age and height, how is your weight considered?
Does your condition improve after time in the sun?
Have you tried UVB light treatment in the past?
Have you tried UVA light treatment in the past?
What did you most like about our web page?
Do you believe UVB is a valid psoriasis treatment?
Do you believe most advertised psoriasis cures are fakes?
Are you considering trying our home base UVB treatment
please tell us how you found our web page
What else could we provide to help you make a decision?
How would you rate our web page, appearance, easy of use etc?
Only if you have had your psoriasis professionally diagnosed, and you know the type of psoriasis you have, please select from our list;
Are you satisfied with the information on our web page?

please tell us a brief history of treatments that you have tried, what was successful, what was not. Anything that you have noticed about your condition.

please tell us if you were looking for particular information regarding your condition, or what information you would like to see on our web page? For example, how could we improve our web page or information, did you find our information accurate etc?

please send me regular email updates

please send me future promotional material by email

Thank you for your time, we appreciate that it is valuable. Don't forget to join our online support form and chat with other psoriasis sufferers!

(please press submit only once and wait for the confirmation page.)

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