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Autoimmune Disease Research
Questionnaire Portion
All questions on this page require an answer.
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1.
Please enter your contact information! (No information will be used without your consent, and you can request to stay anonymous
(Required.)
Name
email address
Facebook (if applicable)
Do you wish to stay anonymous at all times? (will be verified before use of any answers)
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2.
Do you or someone you know have an autoimmune disease?
(Required.)
I struggle with an autoimmune disease.
I know someone who struggles with an autoimmune disease.
I don't know anyone with an autoimmune disease, but am interested in the research behind them.
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3.
What autoimmune disease do you (or someone you know) struggle with, and how long have you/they struggled with it? (Type N/A if you don't know anyone who struggles with an autoimmune disease.)
(Required.)
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4.
What symptoms have you (or the person you know) experienced?
(Required.)
nausea
dizzy/lightheadedness
fatigue
muscle pain
joint pain
insomnia
swelling
headaches/migraines
high-blood pressure
muscle spasms
Other (please specify)
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5.
What types of diets/food restrictions have you (or the person you know) tried?
(Required.)
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6.
What types of exercise are easiest or most beneficial?
(Required.)
yoga
hiking
walking
swimming
stretching
Other (please specify)
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7.
Have you noticed what triggers flareups?
(Required.)
N/A
food choices
environment
weather changes
stress
sleep
seasonal allergies
travelling
working out
Other (please specify)
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8.
What types of treatments/medications seem to be useful?
(Required.)
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