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* 1. Name

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* 2. Email address for future contact

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* 3. Which of these best describes you (please tick one)?

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* 4. What is your gender (if parent/caregiver/partner - please give the gender of the person with lichen sclerosus)

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* 5. How old are you (if parent/caregiver/partner - please give the age of the person with lichen sclerosus)?

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