Fibromyalgia, questionnaire
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Hello, this is a short, easy to fill out questionnaire, that with your permission, I would like to use in our Life stories section. Do elaborate and expand on the comments, as much as you like, but this might help you get started.

First Name: 

Male or Female? 

When were you diagnosed ? 

How long did it take to get a diagnosis ? 

Your age at the onset of symptoms, appox? 

What were your first symptoms? 

What are your current symptoms? 

Other clinically diagnosed conditions ? 

Are you still working? 

What line of work? 

Are you disabled from Fibromyalgia? 

Have you filed for disability? 

What results from the filing ? 

Any prior injuries or trauma? 

Major illnesses ? 

Does exercise help? and if so, what kind ? 

Have you ever have a long lasting virus? 

How has FM affected your life? 

What makes symptoms worse? 

What makes you feel better? 

Been admitted to a hospital for pain? 

What remedies or medications have you tried? 

What results did the remedies have ? 

Additional Comments

Please email the results, with your written consent to use the story to Esta