Medical Adherence survey questionnaire

1. What gender do you identify as?

o AMale

o B. Female

o C. ________ (Short Answer Space)

o D. Prefer not to say

2. What is your age?

o 0 - 15 years old

o 15 - 30 years old

o 30 - 45 years old

o 45+

o Prefer not to say

3. Please specify your ethnicity?

o Caucasian

o African-American

o Latino or Hispanic

o Asian

o Native American

o Native Hawaiian or Pacific Islander

o Two or More

o Other/Unknown
 o Prefer not to say

4. Where is your home located?

o north America/Central America

o South America

o Europe

o Africa

o Asia

o Australia

o Caribbean Islands

o Pacific Islands

o Other: ______

o Prefer not to say

5. What is your education level?

o Some High School

o High School

o Bachelor's Degree

o Master's Degree

o Ph.D. or higher

o Trade School

o Prefer not to say

6. Are you married?

o YES
 o NO

o Prefer not to say

7. What is your current employment status?

o Employed Full-Time

o Employed Part-Time

o Seeking opportunities

o Retired

o Prefer not to say

8. Is the current treatment more effective than previous topical treatments?

o YES,

o NO

9. Is the current treatment easier to use than the previous tropical treatment?

o YES

o NO

10. Does the current treatment have less side effects compared to the previous tropical

treatments?

o YES

o NO

11. The current treatment is more effective than previous systemic treatments?

o YES
 o NO

12. I prefer the current treatment to previous systemic treatments?

o YES

o NO

13. Do you ever forget to take your medicines ?

o YES

o NO

14. Do you ever have trouble remembering when to take your medications?

o YES

o NO

15. Do you ever fail to take a medication because you feel you do not need it?

o YES

o NO

16. Do you ever think that any of your medications are not helping you?

o YES

o NO

17. Do you think any of your medicine is causing a side effect?

o YES

o NO

18. How often do you miss taking a dose of medication?

o YES

o NO