New Remedies
Formulario Brainmech
ID
*
ABC100706
Date of Recording
*
Firstname and Surname
*
Date of Birth
*
Sex
*
M
F
Male or Female
Laterality
*
R
L
D
Right (R) o Left (L) or Different (D)
Diagnose
*
0 / 25
Reason of QEEG or Brain Mapping
*
0 / 25
Medication
*
0 / 250
Mobile or Telephone
*
Email
*
Reference Place
*
Fetal suffering
*
Y
N
Yes or No
Walked Late
*
Y
N
Yes or No
Talked Later
*
Y
N
Yes or No
Enuresis
*
Y
N
Yes or No
Brain Injury
*
Y
N
Yes or No
Low Academic Performance
*
Y
N
Yes or No
Headaches or Migraine
*
Y
N
Yes or No
Feel Bored During the day
*
Y
N
Yes or No
Sleep problems
*
Y
N
Yes or No
Drugs Abuse
*
Y
N
Yes or No
Sensory problems
*
Y
N
Yes or No
Empathy problems
*
Y
N
Yes or No
Motor problems, hemiplegia …
*
Y
N
Yes or No
Problems to pay attention
*
Y
N
Yes or No
Impulsivity
*
Y
N
Yes or No
Difficulties correcting their behaviour
*
Y
N
Yes or No
Psychosis, Delusions, Hallucinations
*
Y
N
Yes or No
Positive thinking Mania
*
Y
N
Yes or No
Depression
*
Y
N
Yes or No
Anxiety
*
Y
N
Yes or No
Work memory problems
*
Y
N
Yes or No
Another memory problems
*
Y
N
Yes or No
Crear entrada
