BREAST IMPLANT ILLNESS DATA COLLECTION SHEET

This is our database system to keep track of the symptoms from Breast Implant Illness. You can track your symptoms and update them on a monthly basis. You need to remember the questionnaire number in order to have access to the data base and update the information. We suggest that you write it down.

CLICK HERE TO ACCESS THE DATABASE

FIRST STEP

You need to log on and then you will see this first:

 

Then you need to write the following information for Account Name and Password:

SECOND STEP

After logging on you will see this. If it’s the first time you log on click on YES.

Then you need to fill in the Information as follows:

Then after filling in the information and you have clicked SUBMIT, you will have this POP up. You need to write down and save the questionnaire Number, since this number is UNIQUE for each patient, and this is your way into the database. You will also receive an EMAIL with the questionnaire number so that you don’t  lose it.

THIRD STEP

After completing steps 1 and 2, you may now fill in the information by clicking on the checks. Once you have clicked on the check the information is automatically saved.