CFS Health Survey Form

1

Name(Keep blank if you prefer to remain Anonymous)

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Age

4

Country

5

Gender

Prefer not to say

Male

Female

6

Length of Illness* This field is required.[ Months/Years ]

7

What do you believe caused your M.E/CFS or Post Viral Fatigue (virus if known or major life event)* This field is required.

8

Before you joined the program, where were you at with your overall health and wellbeing?* This field is required.1- (poor health - 10 great health )

9

After you completed the program, where are you now with your overall health and wellbeing compared to when you started?1 (poor health) - 10 (great health)

10

Before you joined the program, where were you at with physical strength?* This field is required.1 (not good physical strength) - 10 (great physical strength)

11

After completing the program, where are you now with physical strength compared to when you started?* This field is required.1 (not good physical strength) - 10 (great physical strength)

12

Before you joined the program, where were you at with Mindset & Personal Growth?* This field is required.1 (not good mindset) - 10 (great mindset)

13

After completing the program, where are you now with Mindset & Personal Growth compared to when you started?* This field is required.1 (not good mindset) - 10 (great mindset)

14

Compared to when you started the program, have you noticed an improvement in your overall health and wellbeing?* This field is required.

A great deal of improvement

Some improvement

No improvement at all

15

Where are you at now?* This field is required.

I no longer experience any chronic fatigue syndrome symptoms (i.e 6-8 symptoms for 3+months)

I’m on my way to recovery

I’m doing the work and I’m slowly starting to see progress

I’m learning a lot, but things haven’t clicked yet

I’ve seen no change whatsoever from when I started

16

Do you consider yourself recovered?* This field is required.

No – I feel I’m still far off from recovery

I’m on my way, but there’s still a road ahead

I’m very close to full recovery

Yes – I’m healthy and life focused

17

Did the program meet your expectations?* This field is required.

No - it was less than I expected

Yes – my expectations were met, it’s what I expected

Yes - the program exceeded my expectation, I received more than I thought I would

18

Number of emails you received* This field is required.

There were not enough emails – I would have loved more check-ins

The number of emails I received was spot on

Too many emails, it was sometimes overwhelming

19

Are you happy with our current 24/7 community on Facebook?* This field is required.

I love our Facebook group as it is

I would prefer a group that is not on social media

I like our Facebook group, but I would have preferred a more categorised forum where I could go, dependent on where I was at

20

Do you have any other comments or feedback on things that you loved or didn’t love?* This field is required.

21

What are three major wins or breakthroughs you have had since working with us?* This field is required.

22

Testimonials are really helpful for anyone feeling unsure about joining the Mentorship, particularly when they feel that it could be dodgy or a scam. It's important for people to hear from real members who are inside the Mentorship themselves. We would love you to leave some encouraging words below* This field is required.

23

Would you recommend this program to others?* This field is required.

24

Would you be happy for us to use your words as a testimonial on our social media platforms to inspire others?* This field is required.

Yes – happy for you to use my words along with my first name (we won't use your last name)

Yes – you can use my words but please keep me anonymous

No – please keep my words confidential

25

If chosen, would you like to be part of a success story interview?* This field is required.