PD STATUS BEFORE COCONUT OIL THERAPY - OVERVIEW
1. USER ID
*
2. SEX
M
F
3. AGE
4. Years since PD diagnosis
5. Years with PD (retrospective)
6. PD Impact on you BEFORE Coconut Oil
insignificant
modest
moderate
severe
debilitating
7. KETOGENIC DIET
Yes
No
8. Physical Activity Level (5 is Average)
9. Describe structured exercise
10. Medications
11. Supplements
12.Additional Medical issues and other Comments
This form is my first submission of Background material
Yes
No
Submit
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