1st Person Project: Search Failed

1st Person Project: Search Failed

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*Name:
*Age when you had ECT:
*Your gender:
*Country:
State/Province if applicable:
Where was ECT performed (if different than above):
Number of ECTs, if known:
Type, if known:	Bilateral Unilateral Mixed Not sure
Voluntary/Involuntary patient at time of ECT:	Voluntary Involuntary Not sure
Treatments/alternatives tried prior to ECT:
Why was ECT prescribed (symptoms, diagnosis):
*Was your ECT:
In what ways did ECT help you (short & long term):
What negative side effects, if any, did you experience:
If you felt harmed by ECT, what was the reaction of your doctor to your complaints:
Do you still see the same doctor who administered your ECT:
*Choose one to describe the effects of ECT on you:
Would you willingly have ECT again, or recommend it to another:
*In one sentence, sum up your thoughts on your ECT experience:
Email (optional):
Additional comments/your ECT story:

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