Patient Experiences Survey
This survey takes around 5 to 10 minutes to complete.

Questions can be addressed to glennchan /at/ gmail [dot] com
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What is your chronic illness?
If you have more than one, please pick the main illness that started first.
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How did you find out about this survey?  e.g.  r/CovidLongHaulers, a specific Twitter account, etc.
If there is a pre-filled answer below that is correct, please do not change it.
During the worst month of your illness, how long could you walk continuously WITHOUT causing your symptoms or health to worsen?
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In the past 30 days, how long could you walk continuously WITHOUT causing your symptoms or health to worsen?
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During the worst month of your illness, were you ABLE to work?  Specifically, were you able to work the last job you had from before your chronic illness?
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In the past 30 days, were you ABLE to work?  Specifically, were you able to work the last job you had from before your chronic illness?
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For the worst month of your illness, please rate your symptoms on a scale from 0-4.  0 = Symptoms do not bother me, 4 = Worst suffering imaginable.
If you do not have a particular symptom, please choose the first option "Did not have these symptoms".
Did not have these symptoms
[0] Symptoms do not bother me
[1]
[2]
[3]
[4] Worst suffering imaginable
Pain, neuropathy, paresthesia
Depression
Brain fog, memory problems, or cognitive difficulties
Trouble falling or staying asleep
Any bleeding disorders
Any blood clotting disorders (too much clotting)
POTS or feeling faint when going from lying down to standing up
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For the worst month of your illness, please rate your symptoms on a scale from 0-4.  0 = Symptoms do not bother me, 4 = Worst suffering imaginable.
If you do not have a particular symptom, please choose the first option "Did not have these symptoms".
Did not have these symptoms
[0] Symptoms do not bother me
[1]
[2]
[3]
[4] Worst suffering imaginable
Food intolerances / allergies
Intolerance / sensitivity to sound
Intolerance / sensitivity to light
Other chronic illness symptoms not listed above
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For the past 30 days, please rate your symptoms on a scale from 0-4.  0 = Symptoms do not bother me, 4 = Worst suffering imaginable.
If your last 30 days overlap with my worst month of illness, please skip this question and answer the next one.
Did not have these symptoms
[0] Symptoms do not bother me
[1]
[2]
[3]
[4] Worst suffering imaginable
Pain, neuropathy, paresthesia
Depression
Brain fog, memory problems, or cognitive difficulties
Trouble falling or staying asleep
Any bleeding disorders
Any blood clotting disorders (too much clotting)
POTS or feeling faint when going from lying down to standing up
Clear selection
For the past 30 days, please rate your symptoms on a scale from 0-4.  0 = Symptoms do not bother me, 4 = Worst suffering imaginable.
If your last 30 days overlap with my worst month of illness, please skip this question and answer the next one.
Did not have these symptoms
[0] Symptoms do not bother me
[1]
[2]
[3]
[4] Worst suffering imaginable
Food intolerances / allergies
Intolerance / sensitivity to sound
Intolerance / sensitivity to light
Other chronic illness symptoms not listed above
Clear selection
Have you done any of the following due to sensitivity to light?
Please select "None of the above" if you do not have sensitivity to light (light intolerance).
Have you done any of the following due to sensitivity to sound?
Please select "None of the above" if you do not have sensitivity to sound (sound intolerance).
Biological sex
If there is any question on this survey that you do not wish to answer, please leave it blank.
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Age in years
Please use numbers instead of words, e.g. 60 instead of sixty.
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