Thank you for participating in this anonymous survey. Your participation is voluntary and will not affect the care you receive at the Environmental Health Clinic. The purpose of this survey is to improve the care of those who experience Environmental Illness (MCS, ME/CFS, FM, EHS). This survey will take around 10 minutes to complete.

* 1. What is your age?

* 2.  Town of residence in Ontario (optional):

* 3. Which of the following was diagnosed during your time at the Environmental Health Clinic?

* 4. Do you have other chronic illnesses in addition to environmental illness?

* 8. Before my experience at the EHC, I had the following:

* 9. After my experience at the EHC, I had the following:

* 10. Before my experience at the EHC, I was able to engage in exercise or healthy activities.

1 (Strongly Disagree) Neutral
i We adjusted the number you entered based on the slider’s scale.

* 11. After my experience at the EHC, I am able to engage in exercise or healthy activities.

1 (Strongly Disagree) Neutral
i We adjusted the number you entered based on the slider’s scale.

* 12. Please add any further comment below:

* 13. Before my experience at the EHC, I had strategies that helped me cope.

1 (Strongly Disagree) Neutral
i We adjusted the number you entered based on the slider’s scale.

* 14. After my experience at the EHC, I had strategies that helped me cope.

1 (Strongly Disagree) Neutral
i We adjusted the number you entered based on the slider’s scale.

* 15. Please add any further comment below:

* 16. Before my experience at the EHC, I had the social support resources I needed to manage the demands of my illness.

1 (Strongly Disagree) Neutral
i We adjusted the number you entered based on the slider’s scale.

* 17. After my experience at the EHC, I had the social support resources I needed to manage the demands of my illness.

1 (Strongly Disagree) Neutral
i We adjusted the number you entered based on the slider’s scale.

* 18. Please add any further comment below:

* 19. Before my experience at the EHC, I was able to engage in the following activities:

* 20. After my experience at the EHC, I was able to engage in the following activities:

* 21. During my time at the EHC, I experienced the following challenges to accessing the clinic:

* 22. During my time at the EHC, I experienced the following:

* 23. Overall, after my experiences at the EHC, I feel more hopeful in my ability to manage my illness effectively.

* 24. I felt as though the EHC had the resources it needed to support quality of care DURING my time at the EHC.

* 25. I felt as though the EHC had the resources it needed to support quality of care AFTER my time at the EHC.

* 26. To what extent would you say your experience at the EHC has contributed to an improvement in your condition?

* 27. I feel as though the EHC was able to effectively coordinate a transition to continuing forms of care after my last visit.

* 28. Please indicate if any of the following needs are not currently being addressed by health care practitioners ( such as GP, medical specialists):

* 29. Have new environmentally-linked conditions arisen since your time at the EHC? Please select all that apply.

* 30. Do you have any other comments, questions, or concerns?

Thank you very much for your participation in this very important survey!

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