Carries Chiari Connection
A connection for Chiarians
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Questionaire
*Name
*Email address
Age
Do you have Chiari 1 Malformation?
-Select a choice-
yes
No
Unsure
When were you diagnosed? And how has it changed your life?
Do you have a Syrnix?
-Select a choice-
yes
No
What is your gender?
-Select a choice-
Male
Female
What state do you live in?
What are your symptoms?
Have you had Decompression Surgery?
-Select a choice-
Yes
No
Due to have surgery in near future
Do you also suffer from depression or anxiety?
-Select a choice-
Yes
No
Only since my diagnosis
Tell more about yourself
What other disorders have you been diagnosed with?
Do you have family members who have been diagnosed with Chiari?
