Changing Minds Protocol

Monthly Report


Keep track of your child's progress on the Changing Minds protocol.  Below is a PDF that you can print off, fill out and send back to Teresa as an attachment in an email.  You can send it to: changingmindsfoundation@gmail.com and Teresa can give you feedback or suggestions.


Monthly Tracking Chart


or


Copy and paste the chart below into a word document and send to changingmindsfoundation@gmail.com


Changing Minds Foundation

Monthly Chart


Name of Child:                                                                                          Date:

Parents Name: 


Address:                                                                                                                        Phone:

Email:

Diagnosis:                                          Birth date:                               Gender:

Date Started Protocol :


Physicians:


Protocol Agent


Start Date


Current Dose


Dose Changes this Month


Adverse

Side Effects Noted


Positive Effects


Ginko Biloba










Prozac










Phosphatidyl

Choline










Body Bio Balanced Oil









B12/B6

Folic Acid










Vitamins









Other








Please state what observation and changes you have seen in your child in these areas of development for this month.


  • Social/Emotional-

  • Movement/Gross Motor

  • Hand/Finger /Fine Motor-

  • Language-list new words/sentences

 

  • Cognitive/intellectual- thinking, problem solving, reasoning

  • Life Skills-eating, potty training, dressing

 

  • Sleep Patterns

 

  • Medical

  • Other

Please send copy to your physician and to Changing Minds Foundation website. This will help build the case that our kids are better and we deserve treatment and more research toward that end.