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Diazepam
Diazepam
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1. What condition do you use Diazepam to treat/prevent?
 
2. How effective do you think Diazepam has been in treating your condition?
 
3. What do you like best about Diazepam?
4. What do you like least about Diazepam?
5. What is your dosage?
Per
6. How long have you been taking Diazepam? / How regularly?
 
7. Since taking Diazepam, have you noticed any changes in the following areas of health and well-being?
Effect on:
Much Worse Worse No Change Better Much Better
Emotional Well-being
Quality of Sleep
Energy Level
Coordination/Motor Skills
Sexual Health
Appetite
Patience
Confidence
Breathing
Sensitivity to Pain
Mental Clarity
Balance/Equilibrium
Digestion
Skin Complexion
Eyesight
Stress Level
Memory
Blood Pressure
Other General Effects Not Listed Above:
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8. Since taking Diazepam, have you noticed any of the following commonly reported side-effects?
Effect on:
None Mild Moderate Strong Severe
Allergic Reaction
Anxiety
Constipation
Change in Libido / Sex Drive
Diarrhea
Dizziness
Drowsiness
Dry Mouth
Fatigue
Headache
Insomnia
Irritability / Impatience
       
Have you noticed any of the following less commonly reported side-effects?
Effect on:
None Mild Moderate Strong Severe
Nausea
Sweating Increase / Decrease
Tremors
Change in Weight
Amnesia / Memory Loss
Blurred Vision
Confusion
Coordination / Balance Problems
Depression
Disorientation
Hallucinations
Slurred Speech
Aggressive / Impulsive Behavior