SECTION 1
Age __________ Gender: Male/ Female Type of psoriasis (if known):_________ Current treatment:_________________
SECTION 2
TREATMENT 1: SATISFACTION WITH TOPICAL CREAM
Do you use TOPICAL CREAM (creams you apply to the skin) for your psoriasis? Yes □ Please complete the info in the box below No □ Please go to TREATMENT 2
	NOT AT ALL					VERY SATISFIED
1. How satisfied are you with the topical cream treatment you use?	□	□	□	□	□	□
2. How satisfied are you with the safety of the topical cream you use? Think of side effects and complaints about treatment	□	□	□	□	□	□
3. How satisfied are you with the convenience of your topical treatment? Think about ease of application and the time this takes	□	□	□	□	□	□
4. How satisfied are you with the information provided about your topical treatment?	□	□	□	□	□	□
TREATMENT 2: SATISFACTION WITH PHOTOTHERAPY
Do you use PHOTOTHERAPY [Ultraviolet (UV) light treatment] for your psoriasis? Yes □ Please complete the info in the box below No □ Please go to TREATMENT 3
	NOT AT ALL					VERY SATISFIED
1. How satisfied are you with the phototherapy treatment you use?	□	□	□	□	□	□
2. How satisfied are you with the safety of phototherapy you use? Think of side effects and complaints about treatment	□	□	□	□	□	□
3. How satisfied are you with the convenience of phototherapy treatment? Think about ease of application and the time this takes	□	□	□	□	□	□
4. How satisfied are you with the information provided about your phototherapy?	□	□	□	□	□	□
TREATMENT 3: SATISFACTION WITH SYSTEMIC THERAPY
Do you use SYSTEMIC THERAPY (i.e., treatment that affects your whole body [e.g. methotrexate, cyclosporine, retinoids, or biologic drugs]) for your psoriasis? Yes □ Please complete the info in the box below No □ Please return the questionnaire to the box by reception
	NOT AT ALL SATISFIED					VERY SATISFIED
1. How satisfied are you with the systemic treatment you use?	□	□	□	□	□	□
2. How satisfied are you with the safety of the systemic treatment you use? Think of side effects and complaints about treatment	□	□	□	□	□	□
3. How satisfied are you with the convenience of your systemic therapy? Think about ease of application and the time this takes	□	□	□	□	□	□
4. How satisfied are you with the information provided about your systemic treatment?	□	□	□	□	□	□
Any other general comments regarding psoriasis treatment: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
Thank you very much for completing the questionnaire Solihull Dermatology Department