Vitamin B-1 Survey

What is your diagnosis? (Check all that apply)

How long have you been ill?

On a scale of 1-10, with 10 as perfect health, how would you rate your health right now?

YOUR EXPERIENCE WITH HIGH-DOSE VITAMIN B-1 (THIAMINE)

How long have you taken high-dose B-1?

What dosage of B-1 do you currently take?

If you're not currently taking B-1, what is the highest dosage you took in the past?

How has B-1 affected your symptoms?

(If you are not sure if B-1 has made a difference, please check “no noticeable effect.”)

Much BetterA Little BetterNo Noticeable EffectA Little WorseMuch Worse

If you experienced any side effects, how strong were they?

If you experienced any side effects, did lowering the dosage stop the side effects?

Overall, how would you rate your experience with B-1?