RELAPSES

Questionnaire également disponible en français

Complete the Relapse Report form if you think you are having a relapse. This will help you better describe your symptoms to your MS nurse or doctor.




ARE YOUR SYMPTOMS:
AFTER THE SYMPTOMS BEGAN, DID THEY GRADUALLY GET WORSE?



    WHAT ARE YOUR SYMPTOMS? (Check any that apply)




  • Check any that apply:



  • Check any that apply:



  • Check any that apply:



HAVE THESE SYMPTOMS AFFECTED YOUR ABILITY TO GO TO SCHOOL OR WORK?








Call your MS clinic or neurologist right away and provide them with the details of your relapse that you’ve recorded above.
Bring all of your completed sheets (1 form for each relapse) with you to the clinic at your next visit.

You can print this sheet by clicking the Print button below.


Thank you to Colleen Harris, RN, for her assistance in the development of this questionnaire.