© Kent Trussell 2001
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Confidentiality is assured. No names or addresses are sought or will be used. A full explanation of the purpose and intent of this survey can be found here.
Any information submitted will be used only for on-going research into psoriasis and for possible inclusion in future editions of this work. Important news will be posted on this site from time to time.
Please Note: It is essential to include a return e-mail if you require a reply.
If you would prefer to make a comment or offer information without completing the Questionnaire, please do so and then press Submit.
How long have you had psoriasis years
Date of Birth Sex M F
Using the descriptions provided in the book, How I Overcame Psoriasis what type of psoriasis do you currently have
Nummular
Guttate
Pustular
Nails (pitted or onycholysis)
Scalp
Don't know
Is it currently
Mild
Medium
Severe
In remission
What factors have most often influenced your experience with psoriasis
Climate
Diet
Personal Life
Other
Do you recall events which precipitated your first onset (e.g. tonsillitis, vaccination,
pregnancy, stress - also see 'Psoriatic triggers' in How I Overcame Psoriasis)
Please provide details
Describe relief from any particular source
Prescription treatments
Other therapies
Attitude
Have you applied any of the information provided in How I Overcame Psoriasis
Surface treatments
Other details
Other applications you have tried (described in the book or otherwise)
Relaxation techniques
Other - Describe
How much of the information provided in How I Overcame Psoriasis was already known to you
All
Most
50%
Less than 50%
Any other details
Have you consulted any of the following on psoriasis
Dermatologist
Naturopath
Homeopath
Herbalist
Hypnotherapist
Treatments
Please note any treatments you have used recently (last 12 months)
Please Select successful unssuccessful Coal tar or similar orthodox topical applications
Please Select successful unssuccessful Steroid creams / lotions
Please Select successful unssuccessful Natural oils / creams / lotions
Please Select successful unssuccessful PUVA
Please Select successful unssuccessful UVB
Please Select successful unssuccessful Systemic corticosteroids / orthodox drugs
Please Select successful unssuccessful Homeopathic remedies
Please Select successful unssuccessful Herbal remedies
Please Select successful unssuccessful Acupuncture
Please Select successful unssuccessful Hypnotherapy
Sun Exposure
I find sun exposure beneficial Haven't noticed
I live in a climate / environment where sun exposure is unusual
Daily Environment / Activity
City office / Sedentary
Urban / Suburban household
Outdoors / Rural / Active
Coastal / Seaside
Exercise
I exercise daily
Gym / weights
Yoga / stretch
Walk / garden
Swim /surf
I don't do any exercise
Do you have a greater degree of faith in orthodox or alternative medicine
Orthodox
Alternative
Are you one of the following
Meat Eater
Partial-Vegetarian - eat Chicken Fish Eggs Dairy Products
Vegetarian
Vegan
Does your diet normally include any of the 'triggers' described in the book
Yes - Describe
No
Do you believe diet has a direct bearing on your experience with psoriasis
Yes
Not sure
Do you know whether you are a
Fast Oxidiser
Slow Oxidiser
Mixed Oxidiser
(see How I Overcame Psoriasis for further information)
Describe a typical day's diet
Breakfast
Mid-Morning Snacks
Lunch
Mid-Afternoon Snacks
Dinner
Supper
Other (include foods, beverages, diet foods, condiments, junk [Incl. gum])
Alcohol
Use
Don't use
Types Spirit Wine Beer
Regularity Once or Twice a week More than 3 times a week Daily
Only on special occasions
I believe this has an effect on my psoriasis Don't believe
Do you smoke
Yes No
Do you take Dietary (e.g. Vitamin and Mineral) Supplements
Describe a typical day's intake
Do you feel that supplementary intake benefits you
Have you ever undertaken a fast
Never
Yes and I experienced benefits
Yes and I experienced little or no difference
No but I might try it
No and I don't think that I will
Blood Type O A B AB Positive or Negative
Racial Type
Parents' Race(s) country of origin
Mother Father
Don't Know
Body type Ectomorph Mesomorph Endomorph
Weight : Height Ratio
Are you Overweight Underweight Correct weight Don't know / not an issue
Would you describe yourself as
Creative / Artistic
Pragmatic / Methodical
Spontaneous
Suppressed
Anxious
A high achiever
Quiet / Shy
Confident, high self-esteem
Occupation
Unemployed
Retired
Job Satisfaction
Satisfied
Want more
I'd just like to have a job
Religious Orientation
Do you actively practise any of the following
Christian Jewish Islamic Buddhist
Seventh Day Adventist Mormon Christian Scientist
Atheist Agnostic Gnostic
No particular orientation
Do you believe in a continuation of life after death
Yes No Don't know / not interested
What do you think of the concepts of thought and mind power as discussed
in the book How I Overcame Psoriasis
Is there anything in your experience which you would like other psoriatics to share or have the benefit of knowing