Up to Date News

Independent Studies and Research Summaries
 
New Research in Auto-Immune and Inflammatory Conditions

Documented Case Observations: Crohn's-Disease Remission

Histologically verified remission reported by independent medical centres in South Africa and Australia.

Crohn's-Disease Research Programme
Ulcerative-Colitis Research Programme
Systemic Lupus Erythematosus (SLE) Research Programme
 
Patient Experiences and Global Case Reports
Participant experiences documented under independent medical observation.
 
Preliminary Findings
 
Washington State University Research Reference
 
London (St George's Hospital) Independent Study
 
CFIDS Protocol Contacts Worldwide
 
Independent Professional Commentaries
 
Media Coverage
 
Media Coverage
 
German Reference Publication - Dr Nebojsa Petrovic MD
 
U.S. FDA Compliance Notice (2008-2019)
Documentation of product and facility compliance submissions.
 
Public Figures and International Collaborators
 
  Questionnaire
 


CFIDS Research Programme Questionnaire

The first step to participating in the Petrovic CFIDS Research Programme is to complete the CFIDS Questionnaire. This form helps assess whether your health background and current status are appropriate for participation in the research-based CFIDS Protocol Programme.

The questionnaire may take a few minutes to complete. A copy can be downloaded in PDF or Excel format and either printed and faxed to Dr. Petrovic, or emailed directly once filled in. You will need WinZip or similar software to extract the file.
The Questionnaire zip file contains the questionnaire in Excel format as well.

It is recommended that you complete the questionnaire on paper first by downloading and printing it from the PDF/Excel format. This will help you review your answers carefully before submitting them online.

After submission, a confirmation copy of your completed questionnaire will be automatically sent to your email address.

Enter Today's Date  
Date: (DD/MM/YY) *
Contact Details  
Name * Marital Status
Street Address Do you have children? Yes: No:
Street Address 2 Do your partner/children exhibit same/similar symptoms? Yes: No:
Town What is your Profession?
County/State/Province What are your hobbies/physical activities? (past and present):
Post Code
Country
Work Phone No: Medical History (i.e. illnesses, operations, etc.)?
Home Phone No:
Fax No:
Email Address: * Have you been diagnosed with CFIDS/CFS/ME before? If you did, by whom?
Date of Birth: (DD/MM/YY) Please give details of your: Height:
Weight:
Give details of any medications (past and present) Allergies or sensitivities (to any supplements as well):
Current eating habits, favourite foods, food 'cravings': Who referred you/recommended Dr Petrovic’s CFIDS Protocol:
Have you ever been tested for the following: Tick for yes Result:
Coxsackie
Epstein-Barr (EBV)
Cytomegallo
HHV-6
Other Viruses
Lyme disease
Tick Bite Fever (Rickettsia)
Chlamydia
Primary tuberculosis
Please tick the symptoms that apply to you.Tick (for yes) followed by frequency and then intensity (on a scale of 0-5, 5 being the worst) of the specific symptom
Symptom Tick for yes Frequency / Other information (specified by symptom) Intensity
Headaches
Pressure in the head (brain fog feeling)
Cognitive function problems
Memory lapses
Concentration difficulties
Numeric calculation problems
Co-ordination difficulties
Speech difficulties
Blackouts
Depression
Anxiety
Panic attacks
Mood swings
Visual disturbances
Earaches
Sore throat
Stiff neck
Tense shoulders
Heart palpitations
Unusual chest pressure
Digestive problems (constipation/diarrhoea)
Numbness or tingling in muscles
Joint pain
Muscle aching
Muscle Weakness
Cramps (where?)
Backache (where?)
Fatigue that has persisted for at least six months, with the exclusion of all other possible medical reasons and conditions
Waking up tired in the morning
Going to bed exhausted, much earlier than usual
Dizziness
Nausea
Impaired sexual life
Severe PMS
Frequent canker sores (Mouth Ulcers)
Cold or flu symptoms (sneezing, sniffing, post nasal drip.)
Enlarged lymph glands
Low-grade fevers
Hot flushes
Night sweating
Mild or bad Insomnia
Nightmares (unusual & frequent)
Problems with driving, esp. at night
Weight changes
Hair problems (what?)
Skin problems (what?)
Blue complexion, especially on legs
Carpal tunnel syndrome (wrist pain)

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Please press the submit button just once and wait for the confirmation screen.

Submit the Questionnaire:    Reset the Questionnaire:

 
Disclaimer:

This website is maintained for historical and reference purposes only.
The Petrovic CFIDS Health Center has permanently closed its physical premises.
All information is presented for educational and research reference, not for clinical use or medical diagnosis.