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
