Acne Treatment Gap Survey Form
Please complete the Acne Treatment Gap Survey Form to help us better understand your experiences and needs regarding acne treatment. Your answers are anonymous and will help improve future care.
What is your age group?
*
Please Select
Under 18
18-24
25-34
35-44
45 or older
What is your gender?
*
Male
Female
Non-binary
Prefer not to say
How would you rate the current severity of your acne?
*
Mild
Moderate
Severe
Clear (no active acne)
Which of the following acne treatments have you tried? (Select all that apply)
*
Over-the-counter products
Prescription topical treatments
Prescription oral medications
Professional procedures (e.g., chemical peels, laser)
Natural/home remedies
None
Other
How satisfied are you with your current acne treatment?
*
1
2
3
4
5
What are the main barriers preventing you from accessing or continuing acne treatment? (Select all that apply)
*
Cost
Side effects
Lack of effectiveness
Time commitment
Difficulty accessing a dermatologist
Lack of information
Other
How often do you visit a dermatologist for acne treatment?
*
Never
Once a year or less
A few times a year
Monthly
How confident are you in your knowledge of available acne treatments?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
How effective do you believe current acne treatments are overall?
*
Not effective
1
2
3
4
Very effective
5
1 is Not effective, 5 is Very effective
Would you be interested in trying new or alternative acne treatments if available?
*
Yes
No
Maybe
Submit
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