Radiation Sickness Feedback

Help us help you survive the apocalypse!

Please fill out this form to report your radiation sickness symptoms:

Symptom	Description
Nausea	I'm feeling queasy
Vomiting	I'm spewing my guts
Diarrhea	I've got the runs
Fever	I'm on fire
Headaches	My head is about to explode
Other (please describe)

Or maybe you just need some medicinals?

Or perhaps it's just a bad case of the Mondays?

(Note: This is a basic form with some symptoms of radiation sickness. Please fill out this form to help us help you survive the apocalypse.)