Please help us further our understanding of how Hyperhidrosis affects Canadians. Simply take a moment to fill out this form.

It will also help you get the best results from your treatment and provide specific information based on the treatment you have received.

Salutation* Select ... Mr Ms Mrs First Name* Last Name* E-mail Address* Postal Code* Registration Number* Confirm Registration* Age Range* Select ... 12 - 17 18 - 24 25 - 34 35 - 44 45 - 54 55 and over

What are some treatments you have tried in the past?*   Focal injections   Topical treatments (i.e. Drysol®, Secure, Xerac, Hydrosalgel)   Oral medication   Iontophoresis   Surgery   Other     None  Yes    No   Have you ever sought medical advice about your condition?

Which best describes how you feel about your hyperhidrosis? I have felt limited at work and my career due to my excessive sweating. I have felt traumatized or emotionally ‘injured’ by my hyperhidrosis. I believe that hyperhidrosis has negatively impacted some of my personal relationships. I’m tired of spending so much money on new clothes and dry cleaning bills.

What are the specific locations of your treatment?   Axilla (underarms)   Hands   Feet   Face/Head   Other

Please let us know which score best describes your hyperhidrosis:   Score 1 My sweating is never noticeable and never interferes with my daily activities   Score 2 My sweating is tolerable but sometimes interferes with my daily activities   Score 3 My sweating is barely tolerable and frequently interferes with my daily activities   Score 4 My sweating is intolerable and always interferes with my daily activities

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