Acne Clinical Trial Prescreening

1

Participants who qualify receive:

Study treatment at no cost
Compensation for their time and travel expenses
Uber transportation to and from study visits if needed

2

What is the child’s age?* This field is required.

3

Child's Age Value(Do Not Delete)

4

About how many red, inflamed pimples does the child have on the face?* This field is required.

Fewer than 30

30 or more

Not sure

5

Does the child also have acne on the chest or back?* This field is required.

Yes

No

Not sure

6

Could you come to study visits about twice a month for the first few months, and then about once a month after that? The office is located at 📍 16100 NE 16th Ave, North Miami Beach, FL 33162* This field is required.

Yes

No

7

Calculation (Do Not Delete)

8

Thank you very much for participating in this survey. Based on your answers, we believe that you may be ineligible for this clinical trial. However, if you would like a staff member to contact you, please provide your best contact information below.

9

Full Name* This field is required.

First Name

Last Name

10

Email Address* This field is required.

example@example.com

11

Cell Phone Number* This field is required.

Please enter a valid phone number.

12

Best Time to Contact You* This field is required.