Acne Investigator Global Assessment Questionnaire
Complete this questionnaire to assess acne severity, distribution, symptoms, and current treatment status. The form title must remain exactly "Acne Investigator Global Assessment Questionnaire" everywhere it appears.
Patient Profile
Age
*
Sex assigned at birth
*
Female
Male
Intersex
Prefer not to say
Acne Assessment
Primary acne type
*
Comedonal
Papular
Pustular
Nodulocystic
Mixed
Other
Most affected area
*
Forehead
Cheeks
Chin
Jawline
Nose
Chest/Back
Multiple areas
Overall acne severity
*
1
2
3
4
5
Presence of inflammation
*
Yes
No
Symptom impact
*
Rows
None
Mild
Moderate
Severe
Pain/tenderness
1
2
3
4
Oiliness
5
6
7
8
Redness
9
10
11
12
Scarring tendency
13
14
15
16
Prior Treatment and Observations
Current acne treatment status
*
None
Over-the-counter topical
Prescription topical
Oral medication
Procedure-based treatment
Duration of current flare
*
Less than 1 week
1-4 weeks
1-3 months
More than 3 months
Notes and observations
Submit Questionnaire
Should be Empty: