Please complete the form only if you are the person who has Lichen Planus, or you are the person who treats patients with Lichen Planus. The results from this study will be of great benefit to both patients and practitioners.

PLEASE COMPLETE THE FORM ONLY ONCE. THANK YOU FOR PARTICIPATING.

AGREEMENT
NOTE: Please Read before filling out the form

By clicking the `I AGREE' link below,

• You are verifying that you are at least 18 years of age
• You are, furthermore, verifying that you have been diagnosed with Lichen Planus, or are a licensed health professional who treats LP patients.

The information you provide on the survey form will be used for educational and research purposes only, and your answers will be treated confidentially and anonymously.

If you have no problems with these terms, please click `I AGREE' below. And thank you very much for your participation:

I Agree, am at least 18 years old, and Wish to Participate

I Do Not Wish to Participate at This Time