Eczema (atopic dermatitis) Eligibility Questionnaire
Clinical trials have inclusion and exclusion criteria, so we need to ask a few questions to see if you are eligible. If you are eligible, we'll get in contact ASAP and provide you with the full details of the study. If not, we can keep you in mind for future studies.

If you prefer, you can just give us a call on 03 9509 6166 or email us at info@emeritusresearch.com and ask for more information on our eczema (atopic dermatitis) studies.

Our privacy policy can be viewed here: https://www.emeritusresearch.com/privacy-policy/
Email address *
Please answer these questions so we can assess your eligibility...
Have you been diagnosed with eczema or atopic dermatitis? *
If diagnosed, how long ago?
Does the rash make you scratch? *
Has your skin thickened or become leathery due to scratching? *
Do you or your family have a history of asthma, hayfever or eczema (other family members for eczema)? *
Have you treated your atopic dermititis with pharmacy medicine and had an unsatisfactory response after at least 4 weeks treatment? *
What treatments are you using now and tried in the past?
Your answer
How much of your body is covered by the rash? *
Your palm area represents around 1% of your body. For example, 2 palm prints of psoriasis is 2%.
First Name *
Your answer
Last Name
Your answer
Phone number *
Your answer
What is your year of birth? *
Your answer
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