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EFTA00262389 | EFTA00262393 0.2010 Dec acne PO Box 432 , Port Mae SA 5540 Ph ts1444Pr M ER tiE.Ar3.5) nocK r3f5 - 6r'/Au- 3/12/10 STATISTICAL OVERVIEW STUDY SURVEY FORM Please complete all questions and return the form in the self addressed envelope by 30/12/10? Thank youfor your support and participation in this important medical study. Please mark boxes with an x. if you answered NO to question 1, please answer questions 6 -13 only. El Director Please specify ocalspatiorr ElGeneral practrlioner O Manager Q.1 Do you currently have visiting specialists, e-g Dermatologists, consulting from within your centre? Unsure CI NO Yes ❑ O Q.2 What specialist/s do you currently have visiting and consulting from within your centre? O Immunologist ❑Allergist O Dermatologist [3-Dietician ❑ Sports Therapist O Other, please specify : Q.3 How often do the specialists consult within your centre? O Every 6 weeks O Every 8 weeks O Every 12 weeks O Other, please specify : refer your patients to, in Q4 in which Regions or Medical Centres do you currently for specialists services? order to receive consultations and treatments ❑ Regional Medical Surgery 's O Regional hospital O Metropolitan Specialists ❑ Privatel'tactices El Surgery currently employed at Please Specify : Pg 1 EFTA00262393
April 25, 2026 at 5:07 PM