Hi. I'm trying to organize, similarities/differences and rates of success/failure among CFS/ME/FMS sufferers.
How would you feel about answering this questionnaire to help me help us?
Gender:
Age:
Height:
Weight:
What condition do you have?
How long have you had it?
What's your principal problem (pain, fatigue, etc)?
What's all your symptoms?
In a comparison how are you now (better than last year, worse than ever, symptom free etc...)?
Do you smoke/drink/use other drugs:
Do you have any other illness/problem?
Do you work?
Do you have children?
What treatments have you tried (please decribe the goal, what did succeed, what did fail and what do you still do)
What doctors have you consulted with? How was it? (put here what you feel it would be useful)
What are you still willing to try?
Additional info:
How would you feel about answering this questionnaire to help me help us?
Gender:
Age:
Height:
Weight:
What condition do you have?
How long have you had it?
What's your principal problem (pain, fatigue, etc)?
What's all your symptoms?
In a comparison how are you now (better than last year, worse than ever, symptom free etc...)?
Do you smoke/drink/use other drugs:
Do you have any other illness/problem?
Do you work?
Do you have children?
What treatments have you tried (please decribe the goal, what did succeed, what did fail and what do you still do)
- Allopathy:
- Homeopathy:
- Naturopathy:
- Orthomolecular:
- Diet:
- Physical (exercise, massage, acupunture, etc...):
- Mind/body:
- Other:
What doctors have you consulted with? How was it? (put here what you feel it would be useful)
What are you still willing to try?
- Allopathy:
- Homeopathy:
- Naturopathy:
- Orthomolecular:
- Diet:
- Physical (exercise, massage, acupunture, etc...):
- Mind/body:
- Other:
Additional info:
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