Chronic Illness Feedback Survey
This survey is for those who suffer from chronic illness or know someone who does.  All questions are optional, so if a question does not apply to you, just leave it blank.  All information is confidental and will be discarded after use.  As a thank you for your feedback, please accept 5 free printables to encourage you on your journey.
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Name
Email Address
Gender
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Do you have any children living at home?
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If yes, how many and what age ranges?
What is the illness you or the person you know suffers from?
If you are a caregiver, friend, or relative of someone with a chronic illness, what is your relationship to that person?
How long have you or the person you know suffered from this condition?
What are the symptoms of this particular condition(s)?
What discourages you the most about your illness?
How do you stay positive?
What are some things people do or could do to make your life easier?
What are things people do that are not helpful?
If you are a caregiver, what are some things you try to do to help those in your care?
What type of content would you find most helpful as one who suffers from chronic illness or knows someone who does?
Check all that apply
Do you have a personal testimonial regarding your illness which you would be willing to have shared in an ebook?
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Are you willing to be contacted for follow-up information if necessary?
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Is there anything else you would like to share regarding chronic illness?
Submit
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