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Retake the questionnaire in 6 months to track your symptoms.

You can send the questionnaire results to your e-mail address or an e-mail address of your choice. The email address will be used only for transmission of the results and will not be kept or used for any other purpose.

 
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Next steps

1

Make an appointment with your doctor

The sooner, the better.

Don’t forget to share this document with your doctor. If you have their email, you can send it to them right away.

Else, print this document and bring it with you the next time you see them.

Create an appointment reminder America/New_York Make a doctor’s appointment to review my MS symptoms Bring my filled out Your MS questionnaire. Discuss my MS symptoms: Physical Cognitive Emotional FREQ=MONTHLY;INTERVAL=3;BYMONTHDAY=1
2

Set a reminder to do it again in 6 months

Tracking your symptoms is key. Add a reminder to your calendar right away to remember to take the questionnaire again in six months.

For privacy reasons, we recommend you avoid using your professional agenda, especially if it’s shared with colleagues.

Set a recurring reminder America/New_York Your MS Questionnaire Reminder Ready to track your symptoms? This questionnaire focuses on the past 6 months, and will ask about any relapses, your symptoms and their impact on your daily life. That’s why we recommend you redo this questionnaire every 6 months. If needed, ask a family member, partner or caregiver for help and input when completing the questionnaire. www.myrules.ca/en/your-ms-questionnaire/ FREQ=MONTHLY;INTERVAL=6;BYMONTHDAY=1
3

Keep this document in a safe place

This is the only copy of your answers. We don’t keep it on our server.

In order to see the evolution of the symptoms, it’s important that you keep the file in a safe place. You can keep it on a private cloud (Dropbox, Google Drive) or on your computer. You can also keep a printed version in a dedicated folder.

KNOW SOMEBODY WHO CAN USE THIS QUESTIONNAIRE? Send it to them.

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Catch up with what My Krew is posting on social. These are your spaces – share your stories and experiences using #MyKrew and help us create a full picture of what MS can look and feel like, from the people who live it – people like you.

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