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*First Name
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Address 1
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[day]
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*Ethnicity
[Select Ethnicity]
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*Gender
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*What is your experience with melasma?
[Select an answer]
I was diagnosed with melasma by a healthcare professional.
I believe I have melasma through self-diagnosis.
I do not know if I have melasma.
*How do you currently treat your melasma?
[Select an answer]
Tri-Luma® Cream
EpiQuin® Micro
Lustra®/Lustra-AF®/Lustra-Ultra™
Prescription hydroquinone
Over-the-counter treatment
Laser/light therapy
I do not currently treat my melasma.
Other
*Do you consistently use a broad-spectrum sunscreen with SPF 30
or higher?
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Yes
No
*Are you pregnant or have you recently given birth?
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Yes
No
*Are you currently taking oral contraceptives and/or undergoing
hormone replacement therapy?
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Yes
No
*What is your primary source for health care information?
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My physician
A nurse/other health care professional
My insurance company
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