• Demodex Blepharitis Jotform Questionnaire

  • Hi there. Thank you for your interest in our project featuring Men with Demodex Blepharitis!

    Please fill out the survey below ASAP. It should only take a few minutes. Once submitted, you may be contacted by a GENUINE Casting Team member for a follow-up video interview to be viewed by our team and clients.

    If you experience difficulty taking this survey or have questions about the project, please contact GENUINE at recruiting@genuinerp.com

    If you have any questions about the information you provide to us, you can read GENUINE's Privacy Policy.

    Okay, let's get started!

  • Format: (000) 000-0000.
  • Are you legally permitted / allowed to work in the United States?*

  • We'd like to learn more about you, so tell us a little about yourself.

  • During this survey, we will be asking you about your medical history/health as it relates to your diagnosis of Demodex Blepharitis. Please select "I agree" below if you are willing to share information about your health as it relates to your diagnosis for the purposes of recruiting for this project.

     

  • By selecting one of the options below, you acknowledge that you have read and understand the above statement.*

  • Now we'd love to hear about your experience with Demodex Blepharitis.

  • Have you been diagnosed with Demodex Blepharitis ?*
  • Who diagnosed your condition?*
  • How often do you experience symptoms?*
  • Can you describe when you first noticed symptoms? What were they like? (Select all that apply)*
  • Have you received treatment for your Demodex Blepharitis?*
  • If yes, which treatments have you tried? (Select all that apply.)*
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  • Thank you so much. Just a few more questions and you'll be done.

  • Our company and our client do not discriminate on the basis of gender identity, gender expression and ethnicy/race. In order to track the effectiveness of our recruiting efforts and ensure we consider the needs of our project, please consider the following questions optional.

  • What is your age range?*
  • What is your ethnicity/race?
  • What is your gender?
  • As a part of the final selection process, would you consent to a Background Check?*
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  • How did you hear about this project?*

  • GENUINE is always looking for people to share their stories and appear in paid advertising campaigns for major brands including American Express, Chipotle, and Walmart to mention a few.

    If you would like to hear about our latest casting opportunities, join GENUINE's mailing list.

    YOU ONLY NEED TO REGISTER ONCE, so if you receive our emails, please check, "I am already on the GENUINE Mailing List".  Thank you!

  • Would you like to be added to GENUINE's mailing list?*

  • Thank you so much for taking the time to answer all of our questions.

     Please click on the "Submit" button to complete your survey.

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