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FIBROMYALGIA SURVEY

Welcome to the FIBROMYALGIA SURVEY web site. I am a high school student with a severe case of Fibromyalgia (FMS), and in order to better understand the changes that are occuring in my life, and to create more awareness around me I decided to conduct my "senior project" on FIBROMYALGIA". My project focuses on how Fibromyalgia alters our lives "physically, mentally, emotionally, spiritually and socially". To truly understand each of these aspects fully, I must understand the science and mathematics behind FIBROMYALGIA. One method I find would be very beneficial is a survey from fibromyalgia patients. The purpose of this survey is to create a better undestanding of real life statistics of those dealing with Fibromyalgia on a day-to-day basis. I would greatly appreciate if you could fill out the 'SURVEY FORM". This information will be used to better understand and assist in improving "awareness" for Fibromyalgia sufferers. I thank you for your time and patience; and to say thank you.

Loretta

FIBROMYALGIA SURVEY FORM

Age:_________________________________________________________

Gender:_______________________________________________________

How long have you been diagnosed with FMS?______________________________

How long have you had the symptoms of FMS? _____years _____Months

Rate your average pain level 1-10: _____________

Rate your knowledge of FMS prior to diagnoses::

_______________________________________________________________

Rate your knowledge of FMS after diagnoses:

_______________________________________________________________

Rate your success in treating symptoms of FMS 1-10:____________________

List 3 top methods personally used in treating symptoms:

1. ___________________________________________________________

2. ___________________________________________________________

3. ___________________________________________________________

Do you also suffer from depression:: Yes _____ No ______

Do you suffer from any other ailments, if so, what are they?

_______________________________________________________________

What has having Fibromyalgia altered most in your life or lifestyle?

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Any additional comments are welcomed in this survey

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Please copy and paste the SURVEY above and fill in the pertinent information and "Contact US" with your responses. Thanking you in advance

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