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1. Multiple Sclerosis Survey

Thank you for taking part in this survey. It has been designed to study factors associated with multiple sclerosis as part of a college dissertation project.

All information gathered by this survey will be remain confedential and anoymous. If you have any queries, please contact me at nickclarke86@googlemail.com.

1. What is your age?

2. What is your gender?

3. What is your country of residence?

4. Have you ever been diagnosed with Multiple Sclerosis (MS)?

5. What sub-type of MS have you been diagnosed with most recently?

6. Do any of your blood relations suffer from MS? If yes, plese state their relationship to you.

7. Which statement best describes your smoking habits?
(If you choose option 3, stating that you have never been a smoker, please proceed to the end of the questionnaire and submit your answers).

8. At what age did you begin smoking regularly?

9. Approximately how many years have you smoked on a regular basis for?

10. On average, how many cigarettes have you smoked a day since you began smoking? If you no longer smoke, please state how many cigarttes you used to smoke a day on average.