Complementary options medical treatment |
Have you used this treatment in the last year? |
How many times have use this treatment in the last year? |
Have you experienced any positive effects of this treatment? |
Have you experienced any side-effects or undesirable effects of this treatment? |
Does your regular doctor know that you are using this treatment? |
Spirituality/religion |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Motion/physical activity |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Nigella sativa |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Zamzam water |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Complementary options medical treatment |
Have you used this treatment in the last year? |
How many times have use this treatment in the last year? |
Have you experienced any positive effects of this treatment? |
Have you experienced any side-effects or undesirable effects of this treatment? |
Does your regular doctor know that you are using this treatment? |
Natural resources or natural products, if YES specify what kind? ______________ ________________________________
Lemon, curcumin, ginger ________________________________ |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Honey |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
yoga |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Meditation |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Psychotherapy |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Vitamins |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Probiotics |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |
Additional information: ................................................ |
q Yes q No |
q 1 q 2- 5 q 6-10 q >10 |
q Yes q No |
q Yes q No |
q Yes q No |