This questionnaire is for those who have been diagnosed with EMS and also for those who suspect they may have EMS though have no diagnosis. There have been no new large-scale studies since the early 1990s on the progressive effects of EMS, and none are in the works now. EMS affects people in many different ways, and although there is no cure for EMS, how the symptoms of the illness are managed varies from person to person.

In order to gather the latest facts on this disease, NEMSN is collecting data. We would also like to keep in touch with you and answer your questions, if we can. Please fill out this questionnaire. All names will be kept confidential.

Alternatively, you can provide us with the following information by sending an email to

Please note, all fields marked with * are required.

Have you ever taken L-tryptophan supplements?
Have you ever taken other products containing L-Tryptophan?
Have you ever taken 5-HTP supplements or any products containing 5-HTP?
Have you ever taken melatonin supplements or other products containing melatonin?
Have you taken any other supplement that you suspect of making you sick with EMS-like symptoms?
Were blood tests done at the time you got sick?
Did your blood tests show a high eosinophil count (a type of white blood cell)?
Were you diagnosed with EMS?
Have your symptoms changed with time?
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