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Quiracnetics
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What is your age?
Under 18
18-20
20-22
22-25
25 and above
2
What is your gender?
Female
Male
Non-binary
Other,
3
How would you rate the severity of your current acne?
Mild
Moderate
Severe
Very severe
4
At what age did you first experience acne?
Select one or more answers
Before 13
13-16
17-20
21-25
After 25
5
How often does acne impact your daily confidence?
Never
Rarely
Sometimes
Often
Always
6
Statement; ''Acne has affected my mental health?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
7
What treatments have you tried?
You can select multiple answers
Creams
Oral medications
Natural remedies
Professional treatments
None
Other,
8
What lifestyle factors affect your acne?
You can select multiple
Diet
Stress
Sleep
Exercise
Hormones
9
Would you be interested in comprehensive acne management support?
Yes
No
Maybe
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