Survey for "Living with Chronic Illness"

This survey should take just a few minutes. I am writing for Marcinson Press about living with chronic diseases and conditions. We hope that your answers will help readers understand what you are going through and how to help. By agreeing to participate in the survey, you're agreeing to have your answers made public as part of the survey's collective response. Please remember that you always have the option to simply not answer questions that you find uncomfortable. You'll have an opportunity at the end of the survey to add (at length) anything else you'd like to share.

I'm going to ask you to give me your name. If you'd rather not disclose who you are and I want to use your answers, I'll make up a name for you. Obviously, you can do that for yourself, too.

Thank you for sharing your experiences. If you'd like to contact me for more information or to share something even more specific or detailed, please write me at

Jean Bolduc

* 1. What is your chronic medical condition? Check all that apply.

* 2. Please provide your age, gender and location in the world.

* 3. How many medicines are you taking for your condition(s)?

* 4. How many doctors do you see to manage your condition?

* 5. Tell usĀ about your care team. Please check all that apply.

* 6. Now I want to ask about how your family relationships have been affected by your illness. Please check all that apply and add more comments at the end if I've missed anything.

* 7. Do family members give you unsolicited advice about managing your condition?

* 8. If you are employed, what are the issues at work that you find challenging (related to your illness)? Please check all that apply.

* 9. If you'd like to share your real name with us, now's the time!  If not, just say "no, thanks" and we'll choose a superhero name for you if your story is featured in the book. If you do share your name (telephone or email), please also include contact information so we can verify that you are really YOU!

* 10. Thanks for participating in this survey!  Now, here's your chance ... please tell us anything else that you think we should know about your experience in living with chronic illness or a question you would like to ask. If you'd like to work on a longer response and submit it separately, please email me at Thanks again!