SensiStop Full Remedy Pack

 

Please answer as many as possible of the questions below.

Patient Name
Date of Birth (dd/mm/yy)
How long did you take SensiStop for?
Did you follow the dosing instructions?
Other drugs taken concomitantly with SensiStop (if any)
Did SensiStop relieve your symptoms?	-SELECT- No Slightly Moderately Very much
If you experienced any side-effects what were they?

Thank you for your kind co-operation.