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Community Skin Health Event
junio 7 @ 10:00 am
-
5:00 pm
Gratuito
«
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»
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Detalles
Fecha:
junio 7
Hora:
10:00 am - 5:00 pm
Coste:
Gratuito
Categorías de Evento:
Marathon
,
Outdoor
Etiquetas del Evento:
Educational
,
Free health screening
,
Outdoor
Organizador
City of Doral
Recinto
Community Skin Health Event
Local Park
Doral
,
33155
United States
+ Google Map
Screening Form Atomic Dermatitis (Eczema)
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Pediatric Atomic Dermatitis Prequalification Form
Is your child between the ages of 1 and 12 years old?
Yes
No
Has your child been diagnosed with atomic dermatitis (Eczema)?
Yes
No
Not Sure
On a scale of 1 to 10, how much is the level of itchiness, being 1 moderate to 10 more severe?
1-3 Moderate Itch (Noticeable to distracting)
4-6 Intense Itch (Frequent scratching, constant urge, very distracting).
7-10 Severe Itch (Overwhelming).
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Screening Form Alopecia
Newsletter
Pediatric Alopecia Prequalification Form
Choose an option according to your child age?
From 2 to 5 years old
From 6 to 11 years old
Has your teen been diagnosed with Alopecia Areata by a doctor?
Yes
No
Not Sure
How long has your teen had this current episode of hair loss?
Less than 6 months
6 months to 5 years
5 to 10 years
More than 10 years
Approximately how much of your teen's scalp hair has been lost?
Less than 50%
About half (50%)
More than 50%
Nearly all or all
Are you able to travel to our Miami, FL clinic for study visits?
Yes, easily
Yes, with some planning
Probably not. I need to know more
Are you able to travel to our Miami, FL clinic for study visits?
Yes, easily
Yes, with some planning
Probably not. I need to know more
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Email
I consent to have this website store my submitted information so they can respond to my inquiry.
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Screening Form Vitiligo
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Pediatric Vitiligo Prequalification Form
Is your child between the ages of 2 and 11 years old?
Yes
No
Has your child been diagnosed with nonsegmental vitiligo?
Yes
No
Not Sure
Is your child’s vitiligo limited to no more than 10% of their face and body?
Yes
No
Not Sure
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Email
I consent to have this website store my submitted information so they can respond to my inquiry.
Submit Form
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Screening Form Vitiligo
Updates
Pediatric Vitiligo Prequalification Form
Is your child between the ages of 2 and 11 years old?
Yes
No
Has your child been diagnosed with nonsegmental vitiligo?
Yes
No
Not Sure
Is your child’s vitiligo limited to no more than 10% of their face and body?
Yes
No
Not Sure
Contact Info
Email
I consent to have this website store my submitted information so they can respond to my inquiry.
Submit Form
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