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Research / Trials / Day 90

Checkpoint 3

Day 90 — Final Questionnaire

Capture your overall change since baseline to complete your efficacy trial record.

Pending HREC approval — this questionnaire is a preview and cannot be submitted yet. You can still explore it and save a draft.

0% of required fields complete

Current medicine and dosage

How consistently have you taken your medicine?*

Any dosage changes since Day 45?*

YesNo

Same scales as Day 1 and Day 45 for full trial comparison.

Sleep quality*

ExcellentVery poor

Quality of life*

Best possibleWorst possible

Daily functioning*

Fully functionalUnable to function

Experienced side effects?*

YesNo

Compared to Day 1, condition is*

Would you continue current treatment?*

YesNoUnsure

Additional comments

Overall treatment satisfaction*

Not satisfiedVery satisfied

Met your primary treatment goal?*

Would you recommend this treatment?*

YesNoUnsure

Continue treatment beyond trial?*

YesNoDiscuss with prescriber

Any concerns about long-term use?

Preferred ongoing treatment plan

Submission is disabled — you can still explore and save a draft.

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