Follow up after Botulinum Toxin A Treatment 

  • Follow up after Botulinum Toxin A Treatment 

  • Dear Patient,

    We sincerely appreciate the trust and confidence you have placed in us for your healthcare needs.

    We kindly ask for your cooperation in completing the following questionnaire as part of your follow-up process after your recent treatment. Your valuable feedback is instrumental in helping us enhance our services and ensure we are providing you with the best possible care.

  • Date of Birth *
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  • Date of last treatment
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  • Date of next treatment
     - -
  • Prior to treatment, what was the average frequency of your headaches?*
  • After treatment, what was the average frequency of your headaches?*
  • Prior to treatment, how long did your migraine headache (s) last, on average?*
  • After treatment, how long did your migraine headache (s) last, on average?*
  • Prior to treatment what was the average intensity of the headaches? (Scale 0-10: 0 no pain. 10 the worse imaginable pain)*
  • After treatment what was the average intensity of the headaches? (Scale 0-10: 0 no pain. 10 the worse imaginable pain)*
  • Have you taken any medications for headaches? (including over the counter medications)*
  • Have you noticed an adverse/negative effects from the injections?*
  • How long does the effect of this treatment last?*
  • Considering your experience with the previous Botox injection, would you consider this treatment option again for the future?*
  • Should be Empty: