| Can I use your information in my book | |
| Please tell me about you | |
| Are you still with your partner | |
| Do you work or stay home | |
| Are you in a group | |
| How long did it take for your doctor to tell you that you had fibromyalgia | |
| How long have you had fibromyalgia | |
| Name: | |
| Email Address: | |
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