Information for Physicians

Physician Materials Request Form

Name:
Specialty:
Institution:
Address:

City:
State:
Zip Code:
Telephone:
FAX:
E-mail:

Please select the materials and note the amounts you would like to receive by mail. For bulk quantities, we request a tax-deductible donation of $5 per bulk pack of 25, made payable to the National Rosacea Society, 196 James Street, Barrington, IL 60010. The patient booklets can be previewed in their entirety within the Information for Patients section.

Patient Education Materials
No. of packs	Supplied in standard bulk packs of 25 ($5 per pack requested donation).
	Understanding Rosacea, an introductory booklet.
	Managing Rosacea, a patient guide for controlling this disorder.
	Coping with Rosacea, a booklet with tips on lifestyle mangagement.
	Rosacea Diary, a diary booklet to help patients find and avoid their personal rosacea triggers.
	Rosacea Triggers, a chart of common rosacea triggers.
	*Rosacea Review*, a patient newsletter.


Professional Materials
	Rosacea Clinical Scorecard, clinical assessment forms (1 tear-tablet of 50).
	Patient Request Cards, allowing patients to order free educational materials from the NRS (1 tear-tablet of 50).
	Office Placard, featuring the standard subtypes of rosacea, including a tear-tablet of patient request cards.
	Faces of Rosacea office poster, with patient photos illustrating the standard classification system.


Article Reprints
	The following items are available as single copies only:
	Wilkin, J et al. Standard grading system for rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology. 2004;50(6):907-912.
	Wilkin, J et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology. 2002;46(4):584-587.
	Blount, BW and Pelltier, A. Rosacea: A common, yet commonly overlooked condition. American Family Physician. 2002;66(3):435-440.
	Lindow, KB and Warren, C. Understanding Rosacea: A guide to facilitating care. American Journal of Nursing. 2001;101(10):44-51.
	Litt, JZ. Recognizing rosacea. The Female Patient. 2000;25:50-58.
	Bikowski, J. Rosacea: The great imitator. Family Practice Recertification. 1997;19:61-65,70-76,81.
	Thiboutot, DM. Acne rosacea. American Family Physician. 1994;50(8):1691-1697,1701-1702.

	Information on specific aspects of rosacea. List below.