Do you live on the Gulf Coast? Please Take this Important Pre- and Post-Oil Spill Health Survey

If you live on the Gulf Coast and feel that your health has been impacted by the Gulf Oil Disaster, please fill out this survey. This survey is intended to gather information and raise awareness about symptoms that are occurring in the Gulf Coast population. Filling it out will take only ten minutes of your time.

Please use the buttons on the right to share this survey with your Gulf Coast friends! Thank you for participating in this important effort.

Click to take the survey on Survey Monkey Now

Survey Preview:

This survey will be presented in 3 parts. The first part will be prior to the DWH disaster. The second part will be during the DWH disaster, as soon as you noticed a change in your health. The third part will be how you are feeling now.

 

Never or almost never Occasionally, but is not severe

Occasionally, but is severe

Frequently, but is not severe

Frequently, but is severe

 

1. Rate each of the following based on your typical health profile prior to the DWH disaster.

 

2. Rate each of the following based on your typical health profile during the DWH disaster, as soon as you noticed a change in your health.

 

3. Rate each of the following based on your typical health profile following the DWH disaster as your current health status.

 

Head – Headaches

Head – Faintness

Head – Dizziness

Head – Insomnia

Eyes – Watery or Itchy

Eyes – Swollen, reddened or sticky eyelids

Eyes – Bags or dark circles under eyes

Eyes – Blurred or tunnel vision

Ears – Itchy Ears

Ears – Ear aches, ear infections

Ears – Drainage from Ears

Ears – Ringing in Ears, hearing loss

Nose – Stuffy Nose

Nose – Sinus problems

Nose – Hay Fever

Nose – Sneezing Attacks

Nose – Excessive Mucous Formation

Mouth/Throat – Chronic Coughing

Mouth/Throat – Gagging, frequent need to clear throat

Mouth/Throat – Sore Throat, hoarseness, loss of voice

Mouth/Throat – Swollen or discolored Tongue, Gums, Lips

Mouth/Throat – Canker Sores

Skin – Acne

Skin – Hives, rashes, dry skin

Skin – Hair Loss

Skin – Flushing, Hot flashes

Skin – Excessive Sweating

Heart – Chest Pain

Heart – Irregular or skipped Heartbeat

Heart – Rapid or Pounding Heartbeat

Lungs – Chest Congestion

Lungs – Asthma, Bronchitis

Lungs – Shortness of Breath

Lungs – Difficulty Breathing

Digestive Tract – Nausea, Vomiting

Digestive Tract – Diarrhea

Digestive Tract – Constipation

Digestive Tract – Bloated feeling

Digestive Tract – Belching, Passing Gas

Digestive Tract – Heartburn

Digestive Tract – Intestinal / Stomach Pain

Joints / Muscles – Pains or Aches in Joints

Joints / Muscles – Arthritis

Joints / Muscles – Stiffness or Limitation of Movement

Joints / Muscles – Feeling of Weakness or Tiredness

Joints / Muscles – Pain or Aches in Muscles

Weight – Binge Eating / Drinking

Weight – Craving certain Foods

Weight – Excessive Weight

Weight – Water Retention

Weight – Underweight

Weight – Compulsive Eating

Energy / Activity – Fatigue, sluggishness

Energy / Activity – Apathy / Lethargy

Energy / Activity – Hyperactivity

Energy / Activity – Restlessness

Mind – Poor Memory

Mind – Confusion, poor Comprehension

Mind – Difficulty in making Decisions

Mind – Stuttering or Stammering

Mind – Slurred Speech

Mind – Learning Disabilities

Mind – Poor Concentration

Mind – Poor Physical Coordination

Emotions – Mood Swings

Emotions – Anxiety, Fear, Nervousness

Emotions – Anger, Irritability, Agressiveness

Emotions – Depression

Other – Frequent Illness

Other – Frequent or Urgent Urination

Other – Genital Itch or Discharge

 

Click to take the survey on Survey Monkey Now