Neurotransmitter Assessment (NTA) – Physical Medicine

  • Please circle the appropriate number on all questions below. 0 as the least/never to 3 as the most/always.
  • Section A

  • Section b

  • Section C

  • Section C1
  • Section C2
  • Section 1

  • Section 2

  • Section 3

  • Section 4

  • Medication History*
  • Please check any of the following medications you have taken in the past or are currently taking.