Biomagnetism for PANS & PANDAS

Who is this form for?

Your Information

First Name *

Last Name *

Date of Birth

Age

Gender

Referred By

Contact Information

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Health History

What brings you in? What are your main concerns?

Was there a clear starting point for these symptoms?

How would you describe the symptom pattern?

Do symptoms worsen after illness or infection?

Anything else you'd like Rachel to know?