6mg Challenge Request
Thank you for accepting the challenge! We are hopeful this can provide a different experience for you regarding LDN. After your form is submitted, we will reach out within 4 business days to collect pharmacy information and provide greater details on how the 6mg challenge works.
Sign in to Google to save your progress. Learn more
First and Last Name *
When did you initially try LDN? Date can be approximate. *
What dose did you initially try? If you do not remember, type NA. *
Did you try a lower dose? *
Briefly describe the symptoms or side effects which required you to stop LDN.  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Root Causes Medical Clinic. Report Abuse
Google Forms