QUESTIONNAIRE
Please fill the information about the patient
1.1 Name *
Your answer
1.2 Surname *
Your answer
1.3 Address *
Your answer
1.4 Age *
Your answer
1.5 Clinical and Functional Evaluation *
(Pathology, onset, evolution, etc.)
Your answer
1.6 Detailed Diagnosis
(If possible, please send us through email clinical exam results like TAC, RMN)
Your answer
1.7 Cognitive condition *
1.8 Involuntary head/neck movements *
1.9 Ongoing antidepressant/painkiller therapy *
Required
1.10 Motivation of the patient towards Augmentative Alternative Communicator *
1.11 Use of other communication aids *
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