The Eczema Society of Canada

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What is your age?
What is your gender?: Female
Male
What is your occupation?
How long have you suffered from hand eczema?: Less than a year
1-3 years
4-5 years
6-9 years
10 years or more
Does your hand eczema cause you to feel self conscious or embarrassed?: Yes
No
Not Sure
Are you less likely to interact with other people because of your hand eczema - for example : are you less likely to shake hands with a person, hold someone's hand?: Yes
No
Not Sure
Are there hobbies, sports or other leisure pastimes that you have had to limit or stop altogether because of your hand eczema?: Yes
No
Not Sure
Have you had to change your main occupation or alter your work environment because of your hand eczema?: Yes
No
Not Sure
Have you ever consulted a dermatologist for your hand eczema?: Yes
No
If you consulted a dermatologist for your hand eczema, please indicate how long ago: During last 6 months
During last year
Between 1-2 years ago
More than 2 years ago
Who are you currently consulting for your hand eczema?: Family physician
Dermatologist
Other
If other please specify
What treatment are you currently using for your hand eczema?
How would you rate the efficacy of your current main treatment?: Doesn't work
Makes a minor difference
Makes a noticeable difference
Works very well
Made my hands clear again
If a once-a-day oral treatment, proven to clear or almost clear hands within 3-6 months, was offered to you, would you try it?: Yes
No
It depends
If it depends please specify
How much would you be willing to pay for this treatment each month (duration of 3 to 6 months)?: $50.00
$75.00
$100.00
$200.00
Other
If other please specify
Do you have a private healthcare plan?: Yes
No
Not Sure