1. Are you currently pregnant or nursing?   Yes*____ No ____

2. Participants must be between 18 – 70 years old. Are you within this age range?   Yes ____ No*____

3. Have you participated in a clinical study within the last month?   Yes*____ No ____

4. Are you in good general health?   Yes ____ No*____

5. Are you using any drugs that might cause skin sensitivity?   Yes*____ No ____  

6. Do you have any know allergies? Yes____ No ____

            If yes, please list them __________________________________________________

10. Do you have a sensitivity to topical products?   Yes*____ No ____

11. Do you have a history of psoriasis, atopic dermatitis, skin cancer, dysplastic nevi or other skin pathology?   Yes*____ No ____

12. Do you have scars on the upper back?   Yes ____ No ____

13. Do you have active dermal lesions on the upper back?    Yes ____ No ____

14. Do you have uneven skin tone on the upper back?    Yes ____ No ____

15. Do you have Nevi, Blemishes, or Moles on the upper back?    Yes ____ No ____

16. Do you have a history of any other condition which might interfere with the test or increase the risk of participation?   Yes*____ No ____

19. Do you have transportation? We are located in Eagan, MN.   Yes ____ No* ____

Findings:          Eligible _______                      Not Eligible: _______