Personal information

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This information is used in the tracking section to filter patients data on certain personal criteria.

The form consists of the following items:

Patient
Sex	Choose Female or Male
Year of birth	Choose the year you were born
Country	Choose the country of residence
E-mail	Specify your e-mail adress
MS
Year of 1st symptoms	Choose the year when first tiny symptoms began, as far as you can remember and most likely were the first signs of MS, in your opinion.
Year of diagnosis	Choose the year when diagnosis has been made by medical professional.
Condition	Choose the disease or the recent type of MS specified by a medical professional: • RR-MS : Relapsing Remitting MS • PR-MS : Progressive Relapsing MS • SP-MS : Secundary Progressive MS • PP-MS : Primary Progressive MS • ADEM : Acute Disseminated Encephalomyelitis • CIS : Clinically Isolated Syndrome • GBS : Guillain-Barré Syndrome • TM : Transverse Myelitis • NMO : Neuromyelitis Optica (Devic's disease)
Highest EDSS	Choose your highest ever EDSS score, self-assessed or physician-assessed, during your illness, not including the periods of MS attacks.
Therapy
MS Drugs	Before the treatment: Please choose Yes if you used MS Drugs more than 50% of the time in 3 months prior to the treatment. After the treatment: Please choose Yes if you used MS Drugs more than 50% of the time after your treatment.
MS Diet	Specific MS diet like Dr. Swank or Best-Bet-Diet of Ashton Embry Before the treatment: Please choose Yes if you were on a MS Diet more than 50% of the time in 12 months prior to the treatment. After the treatment: Please choose Yes if you were on a MS Diet more than 50% of the time after your treatment.
LDN	Low Dose Naltrexone Before the treatment: Please choose Yes if you were on LDN more than 50% of the time in 3 months prior to the treatment. After the treatment: Please choose Yes if you were on LDN more than 50% of the time after your treatment. FDA-approved naltrexone, in a low dose, can boost the immune system. lowdosenaltrexone.org
IBT	Inclined Bed Therapy Before the treatment: Please choose Yes if you used IBT more than 50% of the time in 12 months prior to the treatment. After the treatment: Please choose Yes if you used IBT more than 50% of the time after your treatment. Sleeping under a slight angle for improved bloodflow at night. electroherbalism.com