Self-reporting form
- Name of the therapy/substance: Viagra
- Dosage: 25mg
- How often you took it: once
- Status
- Still using [ ]
- Stopped with no lasting change to initial symptoms [ ]
- Stopped with persistent change to symptoms [x]
- Duration of use: Days [1] Months [ ] Years [ ]
- Response when you started:
- Greatly improved [ ]
- Slightly improved [ ]
- Stayed the same [x]
- Slightly worsened [ ]
- Greatly worsened [ ]
- Current response (if you’re still using) OR Response in the time before you stopped the treatment
- Greatly improved [ ]
- Slightly improved [ ]
- Stayed the same [ ]
- Slightly worsened [ ]
- Greatly worsened [x]
- Lasting changes to initial symptoms after cessation (if you have stopped for more than 3 weeks)
- Greatly improved [ ]
- Slightly improved [ ]
- Stayed the same [ ]
- Slightly worsened [ ]
- Greatly worsened [ ]