2022 Facial Skin Survey - Breakouts and Blemishes

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* 1. First name (your personal information is never shared with anyone else)

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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?

Male

Female

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* 6. What is your age?

Under 18

18-19

20-25

26-35

36-38

39+

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* 7. Which race/ethnicity best describes you? (Please choose only one.)

Native

Chinese

Hmong

Japanese, Koran, Taiwanese or other non-Hmong or non-Chinese Asian

White non-Hispanic

Black

Hispanic/Latino

Multiple ethnicity / Other (please specify)

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* 8. Do you experience acne blemishes or breakouts on your face?

Yes

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* 9. How often do you experience facial acne blemishes or breakouts?

1-3 days per month

3-7 days per month

7-14 days per month

14-21 days per month

21-31 days per month

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* 10. Do you take prescription medication (oral or topical) to help eliminate acne blemishes or breakouts?

Yes

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* 11. What problems or concerns do you have about your facial skin?

	Extremely Concerned	Very Concerned	Somewhat Concerned	Not Very Concerned	Not at all Concerned
Acne Blemishes	Acne Blemishes Extremely Concerned	Acne Blemishes Very Concerned	Acne Blemishes Somewhat Concerned	Acne Blemishes Not Very Concerned	Acne Blemishes Not at all Concerned
Dark Spots	Dark Spots Extremely Concerned	Dark Spots Very Concerned	Dark Spots Somewhat Concerned	Dark Spots Not Very Concerned	Dark Spots Not at all Concerned
Red Spots	Red Spots Extremely Concerned	Red Spots Very Concerned	Red Spots Somewhat Concerned	Red Spots Not Very Concerned	Red Spots Not at all Concerned
Facial scars	Facial scars Extremely Concerned	Facial scars Very Concerned	Facial scars Somewhat Concerned	Facial scars Not Very Concerned	Facial scars Not at all Concerned

Other (please specify)

2022 Facial Skin Survey - Breakouts and Blemishes

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* 1. First name (your personal information is never shared with anyone else)

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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. What is your age?

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* 7. Which race/ethnicity best describes you? (Please choose only one.)

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* 8. Do you experience acne blemishes or breakouts on your face?

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* 9. How often do you experience facial acne blemishes or breakouts?

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* 10. Do you take prescription medication (oral or topical) to help eliminate acne blemishes or breakouts?

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* 11. What problems or concerns do you have about your facial skin?

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* 12. Which photo above most closely resembles your acne blemishes or breakouts?

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* 13. Which photo above most closely resembles your acne blemishes or breakouts?