Physician Materials Request Form

New Professional Members will receive one copy of each patient educational material offered, along with a form to order up to 12 bulk packs at no charge. The National Rosacea Society is also happy to send single copies of its materials to health professionals for free via the form below.

For bulk quantities, we request a tax-deductible donation of $10.00 per bulk pack of 25 to cover shipping and handling. The patient booklets can be previewed in their entirety within the Information for Patients section. Please call 847-382-8971 with questions about your order.

Materials Request Form

Please complete your contact and shipping information, then choose the materials and quantities you would like to receive below. To help cover handling and shipping expenses, we request a tax-deductible donation of $10.00 per standard bulk pack, payable via credit card.

First Name

Last Name

Specialty

Clinic/Institution

Physician Name (if different)

Email Address

Phone number

Website

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Professional Membership

New members will receive one copy of each patient educational material offered, along with a form to order up to 12 bulk packs at no charge.

Professional Membership ($200)

Patient Education Materials

Please select the materials and note the amounts you would like to receive by mail. The Society is happy to send single copies of its materials for free. For bulk quantities, we request a tax-deductible donation of $10.00 per bulk pack of 25 to cover shipping and handling, payable online via credit card.

Standard Management Options for Rosacea handout

Coping With Rosacea booklet

Understanding Rosacea booklet

Recognizing Redness booklet

Rosacea Diary booklet

Rosacea Review patient newsletter

Triggers Checklist tear sheets (pad of 25)

Professional Materials

Please select the materials you would like to receive by mail. The Society is happy to send single copies of its materials for free.

Standard Classification and Pathophysiology of Rosacea reprint (1 copy)

Standard Management Options for Rosacea reprint (1 copy)

Clinical Assessment Scorecard (1 tablet of 50 sheets)

Faces of Rosacea office poster (1 copy)

Grading System reprint (1 copy)

Total (USD) 0

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Our Mission

The National Rosacea Society is a 501(c)(3) non-profit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but poorly understood disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace consultation with a qualified physician. The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us.