Business and Burnout
This questionnaire is designed to research information from leaders in business around burnout and the effects of business trauma on their lives with the intent of sharing the back ground information in a book to support business leaders with burnout.

 All information collected will remain confidential unless you give me explicit instructions at the end of this form to be able to contact you to obtain more clarity or to share the information. Thank you in advance for your openness and honesty!  Dave Fuller, MBA, Author of the book Profit Yourself Healthy
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Tell me a little about yourself *
Required
How old were you when you experienced your burnout? *
How Bad was your burnout *
What was your Job Position when You suffered your Burnout *
How many employees did you have *
How long were you in your position when burnout set in? *
What was the underlying factor that contributed to your burnout- Check all that apply *
Required
Tell me more about the contributing factors if you like.
What are some of the symptoms you are / were experiencing? Please check all that apply *
Required
Your Health - Were you / are you affected by any of the following health issues as a result of your burnout? *
Required
As a result of the contributing factors of your burnout did you experience any of the following? *
Required
As a result of this burnout have you experienced *
How did those contributing factors and that burnout affect  or is affecting your life?
Did you seek medical or professional help during this period of burnout? *
Required
How Long did it take for you to recover from your Burnout if you have recovered?
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If you have recovered from your burnout what did you do that made the biggest difference for you?
What would you recommend to other business leaders who are burned out?
Would you be open to me contacting you to ask for more information about your story for possible use in my upcoming book on Burnout and Business? *
If Yes please put your contact information below. Name, email, phone number
Thank you so much for your help with this research.  Like you I have experienced severe burnout on two occasions in my business career and appreciate your honesty in answering the questions above.  Please feel free to add any additional comments or information you would like to tell me.     Respectfully  Dave Fuller.  
If you would like to be contacted when the book has been written (Fall/Winter of 2021) Please put your email below.
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