JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Join Our Movement
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name:
*
Your answer
Birthday (for our good wishes):
*
MM
/
DD
/
YYYY
Which chronic pain and fatigue condition?
(Instructions: Select as many as apply.
Please name other chronic pain or fatigue conditions in box provided)
*
Fibromyalgia (FM)
Chronic Fatigue Syndrome (CFS/ME)
Myofascial Pain Syndrome (MPS)
Other:
Required
Instructions: Please select whether you are suffering, or are
healed?
Select one:
*
Suffering
Healed
Required
Would you like to be added to our general email list?
*
Yes
No
Would you like to be invited to our group where those healed may help to inspire those still suffering
*
Yes
No
Do you prefer only to be included as a member of our Movement for emails only pertaining to the movement itself?
Yes
No
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
