Weight Management & Chronic Illness Survey

Question Title

* 1. What is your primary diagnosis? (Check all that apply.)

Fibromyalgia

CFS or ME

Lyme Disease

Osteoarthritis

Diabetes

Other (please specify)

Question Title

* 2. Does your current weight concern you?

Yes

No

Question Title

* 3. How much does your weight concern you?

Not concerned at all

A little concerned

Somewhat concerned

Very concerned

Extremely concerned

Question Title

* 4. If you're concerned, would you like to lose weight or gain weight?

I would like to lose weight.

I would like to gain weight.