Progress Follow-Up Form
Provides progress feedback since initial use of Rosacea-Ltd.

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To assist you in improving the appearance and condition of your rosacea, acne or seborrheic-dermatitis skin condition, please complete "all blanks" below. Optional information (up to a full page of your comments) is welcome in the comment section. If you click on the SEND button and are told that your "Progress Follow Up" is not complete, press the BACK button on your browser and check for any incomplete form fields.

Thank you for your feedback!!!

Name:  

File date or order 'date' on personalized letter to you:  
Email address:   
1. How many years do you think that you have had rosacea?  
2. How many years have you seen a dermatologist for rosacea?  
3. What medication have you most recently used "prior" to using Rosacea-Ltd III?  
On a scale of 1 to 10 please rate the appearance of existing rosacea affected skin area after the use of Rosacea-Ltd III:
No noticeable change
over prior product		 Significant improvement
over prior product
4. Are your pimples, papules, or pustules less visible?
0  1  2  3  4  5  6  7  8  9  10 
5. Is any inflammation less visible?
0  1  2  3  4  5  6  7  8  9  10 
6. Do you see less surface area of reddish skin color?
0  1  2  3  4  5  6  7  8  9  10 
7. Do you feel less intensity of redness since you began?
0  1  2  3  4  5  6  7  8  9  10 
8. Other thoughts or comments in reference to the use of Rosacea-Ltd III to make
  • It more efficient,
  • The web site more efficient,
  • or any personal items that you have found in food, lifestyle, or environment that could be helpful to others?
  • or any other comments used in conjunction with 1 through 7 above that could further identify any problem areas, or any other problems resolved.


Please include your answers to the following so we may assist you further.
  1. The number of glasses of water you are drinking each day?   How many should I?

  2. The cleanser you are using to clean your face and if the brand offers more than one cleanser, give us the exact one:   What is a good cleanser?

  3. Are you using a wash cloth with your cleanser? Yes     No   What is recommended?

  4. Are you using the Jojoba oil? Yes     No   What does Jojoba oil do?

  5. Are you using a retinoid, exfoliant, wrinkle remover, Vitamin K, etc.? Yes     No
    If YES, then which one?    What should be avoided?

  6. How many hours each day are you in the sun?   How many is best?

  7. Have you had photoderm/laser surgery, used Accutane, or any topical or oral medications? Yes     No
    If YES, then which one?    What is the effect of laser treatment?

  8. How many cups of coffee, tea, sodas, or alcohol are you drinking each day?   What do they do?

  9. Are you applying a two to four second application of Rosacea-Ltd III to each side of your face? Yes     No   How should Rosacea-Ltd III be applied?

  10. Any other thoughts or unusual considerations that you would like to tell us or ask us?

   



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  Rosacea-Ltd III has a 120 day, 100 percent refund for any reason.