Follow-Up Questionnaire This form is McAfee Secure but it is not HIPAA compliant. Please enable JavaScript in your browser to complete this form.Patient Name *FirstLastEmail *Phone NumberI am the patient.I am the patient's caregiver.Headache PainSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedMemorySignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedMental EnergySignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedConcentrationSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedMotivationSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedMood StabilitySignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedBalanceSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedSleeping HabitsSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedAbility to Work Significantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedAbility to Look at ComputerSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedRelationshipsSignificantly ImprovedImprovedNo ChangeWorsenedSignificantly WorsenedAny other symptoms that have improved or worsened that are not listed above?What challenges are you still dealing with every day?Did you use the 10 days of intranasal insulin? Would you like to use more insulin?Did you use the hyperbaric chamber as prescribed? Or, have you completed 40 hyperbaric treatments already?How is your diet? Did you maintain a ketogenic diet (with low sugar and carbs)? For how long?Do you have any questions for Dr. Hughes?I understand this form is not HIPAA compliant. *YesCaptcha * = PhoneSubmit
