This questionnaire has been adapted from the NIH Patient Reported Outcomes Measurement Information System (PROMIS).
Answer as many questions as possible, only your first name and email address are required.
Your privacy is of the utmost importance, and I will not share your data.
A copy of your submission will be emailed to the address provided.
Each submission opens a ticket in our support system.
The ticket is only closed once your submission has been carefully reviewed and filed.
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