Brain Region Localization Form

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Brain Region Localization Form

The purpose of this questionnaire is to identify difficulties that you may be experiencing. Please answer every question. Do not skip any questions. Follow the 0-4 key, and select which best fits for all your answers

0=I NEVER have symptoms (0% of the time)

1=I RARELY have symptoms (less than 25% of the time)

2=I OFTEN have symptoms (half the time)

3=I FREQUENTLY have symptoms (75% of the time)

4=I ALWAYS have symptoms (100% of the time)

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Full Name *

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Birthday *

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Email Address *

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