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Bioskin® System
CE Certification

Vitiligo is a pathology that recognizes various causes and therefore various treatments. In order to know an indicative appraisal of the effectiveness of the Bioskin® therapy in your specific case, it is necessary to fill in the following questionnaire further to which you will have an answer by mail.

E-mail*(Ex. bianchi@tesene.it)
Confirm E-mail*
Family Name and Name*:
Age*:
Sex*: male  female
Profession:
Residence*:
Address*: number
City*:
ZIP Code*:
Telephone:
Fax:
Age of appearance of Vitiligo*:

Any Cases of Vitiligo in the Family?

Father: no yes
Mother: no yes
Grandparents: no yes
Brothers: no yes
Psoriasis: no yes
Alopecia: no yes

Outbreaking Factors:

Physical no yes
Psychological  no yes
None no yes

.

Vitiligo Current Situation:

Behaviour of Vitiligo to your exposure to sunlight:

Concomitant Pathologies:

Thyroid: no yes
Gastritis:   no yes
Diabetes: no yes
Anaemia: no yes

Approximative percentage of the skin suffering from Vitiligo*: (0-100%)
 

Indicate the areas of the body mainly suffering from Vitiligo:  (essential)

Which Treatments have you tried up until today?
1
2
3
Which results have you achieved? None Mediocre Good Excellent



After having pressed on SEND INQUIRY, wait a few moments for the answer,in case it doesn't show
or if after 2-3 days from SEND INQUIRY you aren't contacted by our staff, please kindly call our number 0039.0572.913.037

 

 
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