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TELL US WHAT IS IMPORTANT TO YOU

*	1.	Please select the statement that most accurately describes your status?


*	2.	How long have you been experiencing symptoms?


*	3.	Have any of your doctors provided proof of a successful treatment protocol for your conditions?


*	4.	Do you work outside the home?


*	5.	If you could find relief from your symptoms, which of the following would mean the most to you?