Survey for Applicants who Participate in Clinical Study for Improving Wrinkles Around the Eyes, Mouth & Neck
** The purpose of this survey is to support the findings of the clinical trial, which evaluates the safety and effectiveness of the procedure to improve wrinkles around the eye, mouth and nose areas, by evaluating observations and experiences before and after treatment with the medical device for wrinkle improvement.

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1.  In order to confirm that you meet the criteria to participate in this clinical study, your medical history and record of medication usage may be collected along with your personal information.  These will be retained for up to 30 days after the completion of the recruitment period of this study and any personal information that is collected will be destroyed after the retention period has elapsed. Do you agree to the collection of personal information, including your name, age, gender and contact information, which are required for participation in this clinical study? *
2. Parts of the survey are to confirm the conditions for participation in the clinical study and based upon information collected via phone calls from the research staff or on visits to the hospital, you may be disqualified from participation.  Do you understand and agree? *
3.  Personal information that is collected in the survey will be provided to third-party clinical trial institutes and the researchers in charge of the clinical study.  Do you agree to provide your information? *
※ The answers to the questions above are not complete, and support is not completed.Did you select all the items? *
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