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GGW Pharmaceutix self survey #666

Date: on what date was the starter dose self administered?
Route
Oral
Other
Inhalation
Was the starter dose taken on an empty stomach 0=empty 10=full
1
2
3
4
5
6
7
8
9
10
What Recreational drugs were also consumed at time of Starter dose?
Improve Focus?
Improved Productivity?
Improved Calmness ?
List any side effects that you suspect may be related to the starter dose for none type "None"
Would you like to sample a stronger dosage?
Yes
No
How likely would you recommend this pill to someone?
Very Likely
Likely
Neither likely nor unlikely
Unlikely
Very Unlikely
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