Your Vitiligo Story: Tell the World
What is your gender?
At what age did you develop vitiligo?
How many months or years have you had vitiligo?
How do you describe your skin tone?
What kind of vitiligo do you have?
Generalized (on both sides of your body)
Segmental (in one confined area on your body)
I don't know
Select any/all activities that have impacted your participation because of vitiligo
Going to work or school
Participating in sports
Making new friends
Being intimate with spouse or partner
attending parties or social events
Shaking hands with others
Before you developed vitiligo, did you participate in more social activities?
Have you ever felt that if you didn’t have vitiligo your life would have been better?
Have you ever avoided or canceled appointments for:
Routine or annual medical procedures
Select each response below that applies to actions you’ve taken because of vitiligo.
Applied self-tanner or make-up to cover my vitiligo
Worn long sleeves, long pants, scarves, hats, or sunglasses etc. to avoid exposing my vitiligo
Avoided going to events, parties, concerts, or other activities that you once enjoyed
Arrived or left early to avoid the crowds
Shopped online instead of at stores
Changed vacation destinations
Ordered take-out instead of dining in at restaurants
Avoided making eye contact with strangers
Permanent or temporary tattooing
Any others you would like to add?
Has your vitiligo ever made you feel sad, discouraged, or depressed?
Are there any comments or thoughts you would like to share?
Managing my vitiligo on a daily basis is a burden?
Do you worry about your vitiligo spreading?
Sometimes, but not a lot
Could vitiligo influence you to NOT have children?
Do you find warm weather more difficult because more of your vitiligo is visible?
Do you feel that your family understands how vitiligo makes you feel?
Do you feel that your friends understand how vitiligo makes you feel?
Have you ever been stared at in public because of vitiligo?
Do you mind when people ask you about vitiligo?
What bothers you about people asking about your vitiligo?
Have you ever seen a doctor about your vitiligo?
Did you feel that your doctor understood or cared about how vitiligo made you feel?
Was your vitiligo ever diagnosed INCORRECTLY by a physician?
If Yes, what did the doctor say you had?
Have you ever used/tried a vitiligo treatment, product, or supplement that you found online?
If you HAVE used an online vitiligo treatment, product, or supplement, what factors influenced your decision to try an online product?
If you HAVE used an online vitiligo treatment, product, or supplement, did it work for you?
One, or some worked well
One, or some worked, but not well
About how many online treatments, products, or supplements have you used since being diagnosed with vitiligo?
Too many to count
If you have used an online vitiligo treatment, product, or supplement, what is the most you’ve spent on these products in a single year?
$50 - $100
$100 - $500
$500 - $1000
More than $1000
Have you ever used a vitiligo treatment prescribed by a physician?
If you NEVER tried a treatment, select all reasons that influenced that decision.
Couldn’t find a doctor to prescribe
Doctor said the treatment wouldn’t work
Insurance wouldn’t cover
Too expensive even with insurance
Too time consuming to use
Too many scheduling conflicts
Afraid of safety or long-term risks
I didn’t care enough to bother with it
If you NEVER tried a treatment, were there ever times you WISHED that you HAD treated your vitiligo?
If you NEVER tried a treatment, but WISHED that you HAD treated your vitiligo, What made you wish that you HAD tried a treatment?
If you DID try treatment/s, did your doctor make you feel encouraged about the treatment/s working?
If you DID try treatment/s, did your doctor explain how long it would take for the treatment to work?
If you DID try treatment/s, did your doctor explain what to expect, or how you could tell if/when the treatment was working?
If you DID try treatments, did insurance cover any part of the treatment cost? Select all that apply.
Yes, it covered the full cost.
Yes, it covered most of the cost.
Yes, it covered a small amount, but I still had to pay a lot.
Yes, my insurance provided coverage, but only after I filed an appeal.
No, my insurance company did not cover any part of my treatment cost.
If your insurance company did NOT cover your treatments, did your physician's office TELL you that you could file an appeal?
If your insurance company did NOT cover your treatments, Did your physician’s office HELP to file an appeal?
At any point in your life was there a treatment/s that you WANTED to try but you were UNABLE to?
If you DID want to try a treatment but were UNABLE to, select all reasons that kept you from trying.
My doctor would not prescribe it for me
My insurance wouldn’t cover it
Too many scheduling conflicts
With or without insurance, it was too expensive
I was afraid of the safety or side effects
If there was a safe treatment that you could afford, that worked well, and you only had to use it once a week, would you consider trying it?
Any other thoughts or comments you'd like to share about this question.
Is there anything that you want the world to know about vitiligo?
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