Atopiclair Club

Treasure your skin with a proven safe and effective, non-steroidal treatment! Join the ATOPICLAIR CLUB and experience relief that goes beyond skin barrier repair to break the itch-worry cycle of atopic dermatitis. You also get exclusive premiums such as:

Samples of select Atopiclair products
Valuable coupon offers and product savings
Our e-newsletter, a great resource for your sensitive skin care needs and info about common skin conditions like eczema, acne, and aging skin

Join the ATOPICLAIR CLUB and enjoy the benefits of a non-steroidal atopic dermatitis treatment that goes beyond skin barrier repair effectively breaking the itch — scratch — worry cycle of Atopic Dermatitis patients.

Name

Age

Gender

Male Female

How did you learn about Atopiclair™?

If others, please specify

1. Are any of the following diseases present in your family?

Asthma Atopic Dermatitis Allergic Rhinitis Food Allergy None of These

2. Have you been diagnosed with any of the following? (Check all that apply)

Atopic Dermatitis / Eczema Contact Dermatitis Psoriasis None of these

3. If you have been diagnosed with Atopic Dermatitis, what treatment did the doctor gave you?

Steroids only Emollient only Combination of steroids and emollient

If others, please specify

4. Have you tried using Atopiclair? Which variant?

Atopiclair Cream 40mL Atopiclair Lotion 120mL Both No, I have not yet

5. Where did you get your Atopiclair?

Pharmacy / Drugstore Doctor’s Clinic Hospital

Congratulations!

Thank you for sharing the above information with us. Now, all you have to do is submit this filled-out form and we will process your ATOPICLAIR CLUB Membership.

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and may not be used without permission. Disclaimer