EPILEPSY HEALTH REVIEW

Please complete all questions below.

Personal Details

Epilepsy Health Review

Have you been seizure free in the past 12 months?

Have you been seizure free in the past 12 months?

Do you experience any side effects from your epilepsy medication?

Do you experience any side effects from your epilepsy medication?

Are you still taking your epilepsy medication?

Are you still taking your epilepsy medication?

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