| 1. |
a. |
Have you heard of the syndrome Fibromyalgia? |
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Yes
Yes, but I am not sure what it is
No (if the answer is No, skip to question #2)
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b. |
Have you or anyone you know been diagnosed with Fibromyalgia? |
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Yes, I have been diagnosed with Fibromyalgia
Yes, someone I know has been diagnosed with Fibromyalgia
Yes, I am a caregiver for someone who suffers from Fibromyalgia
No
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c. |
If the answer to question b is "yes", were you (or they) misdiagnosed with other diseases, conditions, or symptoms? (Yes or No) |
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Yes
No
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If yes, what were they? |
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d. |
Fibromyalgia signs and symptoms (and co-existing conditions) can consist of: (Check all that apply) |
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Widespread pain and tender points
Fatigue and sleep disturbances
Irritable bowel syndrome (IBS)
Depression
Headaches
All of the Above
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e. |
Based on your experience, how effective are healthcare providers at recognizing signs and symptoms of fibromyalgia? |
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Very effective
Effective
Not effective
I have no experience and therefore don't know
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f. |
Comment - How has fibromyalgia impacted you or your family (missed work, no family functions, depression/anxiety, lost contact with friends, etc.)? |
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2.
| Do you think a man's experience with fibromyalgia is different than female sufferers? |
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Yes
No
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If so, why is it different? |
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| 3. |
What type of healthcare provider would you or your partner contact first about fibromyalgia? |
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Family physician/Primary Care Physician
Rheumatologist
Neurologist
Other, please indicate:
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| 4. |
If you were experiencing some of the symptoms of Fibromyalgia, including widespread pain or tender points, fatigues, sleep disturbances, headaches, etc... How long would you wait before consulting a healthcare provider? |
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I would contact a doctor right away
1 - 6 months
6 - 12 months
1 - 2 years
3 + years
I would not consult a doctor
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| 5. |
Where would you go to learn more about fibromyalgia? (Rank 1 to 5) |
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Patient advocacy / education organization
Online health information / resources
Your healthcare provider or pharmacist
Printed health literature or materials
A family member or friend
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Please tell us a little about yourself: |
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