This survey is for anyone who has traveled, plans to travel, or is thinking about moving to an endemic area.

If you wish to read about Valley Fever first, you can click here to return to the Home page.
Otherwise, please fill out the survey below. Your input really does matter.

Name:    Age:  Male   Female

Email:    Phone:

Current Town/State:

Original Home Town/State:

1)	Please select which of the following applies to you: I never heard of Valley Fever before reading about it on this website. I heard of Valley Fever before the first time I went to visit an endemic area.     The endemic town/state was: I heard of Valley Fever after visiting an endemic area.     The endemic town/state was:
2)	If you heard of Valley Fever before reading this website please describe what you thought it was and how you could contract it.
3)	If you read this web site's Frequently Asked Questions or Facts and Commentary, would you still travel or move to any of the endemic areas? If you did not read either of those pages, skip ahead to question #5. Yes    No
4)	Please tell us why you answered yes or no to question 3.
5)	How many years have you lived in or visited each of the endemic areas? Arizona 0    visited    less than 1    1-2    3-4    5+   California 0    visited    less than 1    1-2    3-4    5+   Texas 0    visited    less than 1    1-2    3-4    5+   New Mexico 0    visited    less than 1    1-2    3-4    5+   Nevada 0    visited    less than 1    1-2    3-4    5+   Utah 0    visited    less than 1    1-2    3-4    5+   Mexico 0    visited    less than 1    1-2    3-4    5+   Central America 0    visited    less than 1    1-2    3-4    5+   South America 0    visited    less than 1    1-2    3-4    5+
6)	Were you ever sick with pulmonary problems (such as difficulty breathing or fluid in your lungs, etc.) while living in, visiting, or after leaving an endemic area? NOTE: endemic areas are places in the list above. Whether the symptoms only lasted a few days or had a longer term, please describe your condition or symptoms, how long they lasted, and the approximate month and year they occurred.

Thank you for filling out our survey.