Letter to the Patient

Dear (Pseudonym),

Thank you for making use of Mypsypotential. You may be doing so on the advice of your physician, or you may be taking your own initiative. Either way, you will empower both yourself and your physician with a complete data-basis, rounded off by a diagnosis. Your diagnosis will be made by your physician backed by Mypsypotential's cutting- edge support. Mypsypotential will also discuss treatment options with your physician, and synchronize any combination of medications prescribed by him or her.

Every patient your physician reviews through Mypsypotential is a short, easy refresher course to him or her.

Psychiatry is like a jig-saw puzzle. It comes your way as two thousand pieces in a box. Only the completed picture tells one what the puzzle is about. Your entire dealing with Mypsypotential is to put full information in your physician's hands. If you look at the amount of information you have to work through, you will understand why no doctor could spend the time to go over all those questions with one patient. So you are investing your own time covering all that material on your doctor's behalf., .

Mypsypotential deals exclusively with your physician as soon as you have submitted your form.

Please do each division very well. When you submit it, it will be saved. As soon as you have completed all subdivisions, you will be able to edit your whole questionnaire. Please make sure that you are satisfied with all your data before clicking the 'Final Submission:' button.

You will receive an automated return letter which gives you a coded pseudonym. Please make sure your physician connects your coded pseudonym to your real identity. Mypsypotential will ensure total confidentiality by attaching only your coded pseudonym to your form.

Your physician will receive your form within 24 hours after you and Mypsypotential have agreed that it is complete. You may receive return letters asking you to correct errors or to complete parts you missed.

Greetings,

Dr. Jean Blom M.B.Ch.B. M.Med(Psy)
3906 51 ave
Lloydminster AB
T9V 2Z2

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INDEX OF THE QUESTIONNAIRE

01

Personal Details & Patient Essay

02

Demographic Particulars

03

Genetic & Fetal-background

04

Developmental & Neurological Background

05

Substance Abuse, Social Development & Marriage

06

Mental_Substace-Induced-Disorders

07

Psychotic Disorders

08

Mood & Anxiety Disorders

09

Somatoform - Factitious - Dissociative - Disorders

10

Sexual, Gender & Identity Disorders

11

Eating, Sleep & Impulse Control Disorders

12

Adjustment Disorders & Personality Assessment

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