Intended for individuals that have been diagnosed with an autoimmune disease, thyroid disease, chronic fatigue syndrome, and/or fibromyalgia.

Please select all situations that apply to you.
As a child, I grew up in an impoverished household.
I was involved in or witness to a horrific accident.
As a child, I was neglected and/or abused.
I have survived a natural disaster and or house fire.
While at work or in the military, l experience a traumatic event.
I have been sexually assaulted.
As a child, I was molested.
I have never experienced any type of abuse, neglect, molestation, sexual assault, or any other type of trauma.
As a child, I grew up in a household where one of my parents was abused by the other.
Please select all diagnosis that apply to you.
Autoimmune disease
Thyroid disease
Obesity
Chronic fatigue syndrome
Fibromyalgia
Other
Please Specify:
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