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Hello everyone! I am currently working on a project and am in need of some very specific feedback from a select group of individuals. Including myself, there is a population of people who live with chronic illness. I am looking for these amazing people to fill out a survey that I have created. This questionnaire is aimed at those who live with varying degrees of physical, emotional, or mental ailments. If you or someone you know lives with anything that might fall under that umbrella, I would love it if you wouldn't mind taking some time out of your day to either take this survey yourself or forward it along. However, before doing so, I would ask that you fill out the release agreement attached below. You can either email this document or fax it to me.

All information given is 100% confidential. Any and all names will be removed from the finished product to protect those involved. 


FAX: (949) 858-7933

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