ATOPIC DERMATITIS (ECZEMA) 

Dermatology Life Quality Index (DLQI) and Atopic Dermatitis (Eczema) Questionnare

*This form is only to be completed exclusively by Skin Health Institute patients before their telehealth appointment.

The aim of this questionnare is to measure how much your skin problem has affected your life OVER THE LAST WEEK. Please tick one box for each question.

Atopic Dermatitis Questionnaire

If Yes, please rank how bothersome the following eye symptoms are below. If No, please skip to Question 6.

If on Dupixent or Rinvoq please answer the below questions

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