LDN Mini-Assessment/Opinion

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If you are an adult over the age of 18 years and not certain that you are a candidate for a trial of low dose naltrexone as an adjunctive treatment for a given condition, please complete the following free mini assessment/Opinion and we will get back to you via email with our opinion regarding this. In completing this form you agree that doing so does not constitute a doctor-patient relationship between you and the doctor/provider rendering this opinion nor does it take the place of a standard medical assessment. The results of this assessment/opinion are based on the providers experience and knowledge of the recognized uses of LDN as an adjunct to standard medical therapy and as such may differ from the opinions of other physicians/providers.

Email *

I have read the above and agree with the intent and limitations of this assessment/opinion. *

Yes

Required

What is your age? *

What specific condition(s) are you hoping LDN might help? *

What is your expected outcome from possibly adding LDN to your current treatment plan for the above given condition(s)? *

List all past medical diagnoses, conditions, surgeries and procedures performed. *

List all current prescription medications, supplements, herbs, etc currently being taken. *

Are any other procedures, surgeries, medications, therapies planned in the near future? If so, explain. If not, say No. *

Are you taking any opiate or narcotic type medications at all at this time? *

Yes

Required

Are you currently a resident of Texas? *

Yes

Required

How did you find Texas LDN Doctor? *

Google search

LDN research trust listing

LDN science listing

Facebook

Other:

Send me a copy of my responses.

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