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Symptom Management Survey v4.0
General details
Just to help us identify where each questionnaire is from. All data is protected and will not be passed on to any other source
1.
What is your name
2.
What is your email address (optional, we will not pass on your email address but it would help contact you if anything of interest comes up on your form which may be of help to you)
3.
What region or country do you live in
United Kingdom
United States
Netherlands
Belgium
Ireland
Rest of Europe
Australia
Canada
New Zealand
Africa
Asia
South America
4.
How would you describe your current success at managing your Menieres symptoms
I'm feeling well under control with no vertigo or dizziness and other symptoms are manageable
I'm feeling ok with no vertigo or dizziness but other symptoms are still troublesome
occasional vertigo or dizziness or suffering with other symptoms
some vertigo and dizziness still
regular vertigo and dizziness and unable to control it
