CIRS Life Research Survey Part I
The purpose of this survey is to investigate & identify the needs of those with Complex Chronic Illness(es) (CCI) that may be related to environmental exposures, either past or ongoing as well as CCI that would benefit from living in a community that is controlled for as many variables as possible that can trigger increased chronic inflammation in those genetically predisposed. Common CCI presentations can include;
1. Autoimmune Disorders not clearly defined.
2. Autonomic Nervous System Disorders
3. Biotoxin-Related Illness
4. Chronic Inflammatory Response Syndrome (CIRS)
5. Chronic Fatigue Syndrome
6. Chronic Lyme/Tick-Borne Illness/Insect-Borne illness
7. ElectroMagnetic Field (EMF) Sensitivity
8. Encephalitis (brain inflammation)
9. Environmental Sensitivity
10. Fibromyalgia
11. Gut Dysbiosis
12. Heavy Metal Toxicity
13. Mast Cell Activation Syndrome
14. Metabolic Disorders (including Thyroid, Diabetes Insipidus, Diabetes Mellitus…)
15. Mold/Toxic Mold Exposure
16. Morgellons Syndrome
17. Multiple Chemical Sensitivity
18. Multiple Sclerosis (especially with atypical presentation
19. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strept. Infection)
20. PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)
21. POTS (Postural Orthostatic Tachycardia Syndrome)
22. Toxic Encephalopathy
23. Toxin Exposure
24. Unknown Cause of “Mystery Illness”
25. And others…
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Email *
First Name; (Optional)
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Current Address (number & Street)
Current Address 2 (Apt#, if applicable)
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Current Zip Code *
Date of Birth *
Eg; 01/01/2020
Gender *
If "Other"/"Unknown" please explain
Ethnicity *
National origin as best described...
If "Other"/"Unknown" please explain
Relationship Status *
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