Post-Polio Syndrome
New Health Problems
== Survey ==

Follows is a Free, 39 question survey. If you are unable to use forms, email us for a text version to be mailed back or grab your own via the link:
Survey In Text Format

  Click on Graphic to View PPS Survey Results


PERSONAL INFO:
This is about the person you are filling in the survey for who has PPS,
either you or someone else you are responding for. If you're not sure about a response, make a best guess answer.
( PPS = POST POLIO SYNDROME )

NEW (SINCE ONSET OF PPS) HEALTH PROBLEMS:
No=No New Health Problem since onset of PPS.
if YES, then just rate the severity of the new health problem from 1 to 10 with 1 being very mild and 10 being very severe.

Check your responses carefully please then click on the SUBMIT button. You only have one submission, so make sure it's the way you want it before you SUBMIT it.