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City
   
 
 
 
Age
   
 
 
 
Sex
Male Female
 
 
 
Have you been affected by acne (commonly referred as pimples)?
Yes No
 
 
 
If yes, for how long have you been suffering from acne?
less than 1 year (<1 year) 1 year - 2 years more than 2 years (>2 years)
 
 
 
Have you ever been affected by acne on back?
Yes No
 
 
 
Do you consider it to be a big problem?
Yes No
 
 
 
Does it make you self conscious?
Yes No
 
 
 
Are you comfortable with buying products over the counter [from the chemist/retail store] for it?
Yes No
 
 
 
would you prefer to approach a doctor for acne on the back?
 
Yes
 
No
 
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