Please fill out my Chronic Fatigue Immune
Dysfunction Syndrome (CFIDS) survey


This information is for my private curiousity only. None of the information collected will be released or published. Please don't send me nasty notes telling me that it's my duty or obligation to make these results public. It is not. I value privacy and confidentiality above all.

I have a chronic illness. Simply maintaining this web site pushes my limits -- I do not have the strength or energy to publish survey results. If a published version of this survey is important to you -- please create your own survey site, and I will provide a link to it from here. Then you can go about publishing the results yourself. Until then, my survey is for my private data only -- and the results WILL NOT be made public. Period.

I thank you in advance for your time!! [smiley] (But please remember, if you ask me a question you MUST include your e-mail address. This is an anonymous survey, and I have no way of knowing how to contact you, otherwise. Thanks!!)



Please tell me your first name: (Do NOT hit return)

Your e-mail address (OPTIONAL): (Do NOT hit return)


1) Have you been diagnosed with CFIDS?

Yes -- I have been fully diagnosed with CFIDS.
No -- I do not have CFIDS.
Not sure -- I haven't been fully dx'ed with CFIDS, but I (or my Dr.) feel I may have it.
Not applicable

2) How old are you?

Under 18 years old
Between 19 and 24 years old
Between 25 and 34 years old
Between 35 and 44 years old
More than 45 years old

3) If you've been diagnosed with CFIDS, how long do you believe that you've had it?

Between 0-2 years
Between 2-5 years
More than 5 years
Not applicable

4) If you've been diagnosed with CFIDS, how long since your actual diagnosis?

Between 0-2 years
Between 2-5 years
Between 5-8 years
More than 8 years
Not applicable

5) Do any of your family members have CFIDS?

Yes
No

6) Have you been diagnosed with Fibromyalgia Syndrome (FMS)?

Yes
Not sure -- I haven't been fully dx'ed with FMS, but I (or my Dr.) feel I may have it.
No
Not applicable

7) Have you been diagnosed with Neurally Mediated Hypotension (NMH)?

Yes
Not sure -- I haven't been fully dx'ed with NMH, but I (or my Dr.) feel I may have it.
No
Not applicable

8) How did you hear about my CFIDS/CFS/ME page?

Through the mailing list CFS-Y
Through the newsgroup CFS-L
Through the mailing list CFS-20s
Through an internet search engine
Through word of mouth or a link from another person's web site
Through a link from one of my other web sites
Through a GeoCities Banner Advertisement
Through a listing on GeoCities
Just surfed right on in...
None of the above

If you answered "None of the above" on question 8, will you please take
a moment to tell me how you found my site: (Do NOT hit return)

9) How often do you visit my CFIDS/CFS/ME page?

This is my first time.
This is my second time.
I have been here more than two times.
10) Do you have any suggestions/hints/comments on how to improve my site?





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