Project Lychee

watchLAB welcomes you to the online survey for Project Lychee!

Topic: Health
Incentive: $320
Genders: All Genders
Ages: 18+
Type of study: Pre- Task + Remote Webcam Interview
Length of study: 2 Hours Total
Dates: Monday, July
Location: Nationwide

Before you get started -- some stuff you should know:

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Ready to start the survey?

Contact & Basic Info

First Name

Last Name

Email

Mobile Phone

Gender

City

State

Zip Code

Metro Area

Birthdate (mm/dd/yyyy)

Ethnicity

What is your...?

Highest level of education attained

Employment Status

In which industry are you employed?

What is your job title and occupation?

Martial Status

Household Income

Do you have any children or stepchildren age 18 and under living with you?

Health

Do you experience the following atopic dermatitis symptoms? If so which are the most bothersome

	Yes	No	Most Bothersome
Intense Itching (Pruritus)
Dry Scaly Patches on the skin that may be thickened (ichthyosis)
Painful / Tender / Inflamed Skin
Burning and/or stinging skin
Pink or red rash that appears suddenly
Cracks in the skin
Eye Symptoms (Inflammation of the eyelid, eye watering, red rash around the eyes)
Small rough bumps on skin (Keratosis Pilaris)
Papules (Small bumps that look like pimples without pus)
Thickened, Leathery-looking skin

Are you currently being treated for Atopic Dermatitis?

YesNo

What medication(s), either alone or in combination, have you ever taken for your atopic dermatitis?

	I currently take this product	I have taken this product in the past but no longer take it	I have heard of this product, but have never taken it	I have never heard of this product
Dupixent (Dupilumab)
Eucrisa
Prescription topical calcineurin inhibitors
Prescription topical corticosteroids
Current oral immunosuppressant (e.g MTX: Methotrexate, Cyclosporin)
PUVA (psoralen, and ultraviolet therapy)
Other

If other medication, what medication are you currently taking or have taken in the past?

You mentioned that you take or have taken an oral immunosuppresant, please write down the name of the prescription(s)

As part of the screening process, you may be asked to provide a photo of the medication(s) that you currently take. This would be a photo of the actual tube/bottle/box/syringe (i.e. the medicine itself) that you have at home and your first name written on a piece of paper next to the medicine. Are you willing to provide such a photo, if requested? (Please note that images pulled from the internet will NOT be accepted)

Yes, I am willingNo, I am not willing

Does the patient experience the following atopic dermatitis symptoms? If so which are the most bothersome?

	Yes	No	Most Bothersome
Intense Itching (Pruritus)
Dry Scaly Patches on the skin that may be thickened (ichthyosis)
Painful / Tender / Inflamed Skin
Burning and/or stinging skin
Cracks in the skin
Pink or red rash that appears suddenly
Eye Symptoms (Inflammation of the eyelid, eye watering, red rash around the eyes)
Small rough bumps on skin (Keratosis Pilaris)
Papules (Small bumps that look like pimples without pus)
Thickened, Leathery-looking skin

Is the patient currently being treated for Atopic Dermatitis?

YesNo

What medication(s), either alone or in combination, has the patient ever taken for his/her atopic dermatitis?

	They currently take this product	They have taken this product in the past but no longer take it	They have heard of this product, but have never taken it	Never heard of this product
..Dupixent (Dupilumab)
..Eucrisa
..Prescription Topical calcineurin inhibitors
..Prescription topical corticosteroids
..Current oral immunosuppressant (e.g. MTX: Methotrexate, Cyclosporin)
..PUVA (Psoralen, ultraviolet therapy)
..Other

If other medication, what medication is the patient currently taking or has taken in the past?

You mentioned that they currently take or have taken an immunosuppressant. Could you please write down below the name(s) of the prescription

As part of the screening process, you may be asked to provide a photo of the medication(s) that the person you care for currently takes. This would be a photo of the actual tube/bottle/box/syringe (i.e. the medicine itself) that you have at home and your first name written on a piece of paper next to the medicine. Are you willing to provide such a photo, if requested? (Please note that images pulled from the internet will NOT be accepted)

Yes, I am willingNo, I am not willing

If chosen for the study will you have access to a laptop or desktop computer with high speed internet in the location where you will be joining the conference?

YesNo

How would you rate your experience level with using a computer?

Minimal - Not very comfortable with computersBasic - can use most program, I am comfortable with using the internetAdvanced - Can install and configure softwareExpert - an advanced user, people sometimes ask me for help with computer problems