Patient: [FPO]
Survey Date: [FPO]
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How would you rate the skin improvement you’ve seen over the past 4 weeks?
FPO
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How satisfied are you with your treatment/clearance within your first 4 weeks on BIMZELX?
FPO
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How clear is your skin compared to when you started?
FPO
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What emotions are you feeling after 4 weeks of treatment? Click all that apply.
FPO
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Explanation
FPO
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Do you agree or disagree with the following statement: BIMZELX delivered fast results.
FPO
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Do you agree or disagree with the following statement: BIMZELX has more convenient dosing
than past therapies:
FPO
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Explanation
FPO
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Using a letter grade, what is your overall rating for/opinion of BIMZELX?
FPO
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Do you agree or disagree with this statement: I’m happy I switched to/started BIMZELX.
FPO
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Explanation
FPO
