BHERI Logo (3)
  • Before completing this form, please ensure that you have already completed an enrollment form and consulted with an enrollment specialist about starting the program. If this is your first time visiting the site, you do NOT need to complete this form for us to receive your information.

Monthly Progress Questionnaire

Please rate each symptom on a scale of 0 (non-existent) to 6 (prohibits work/daily routine).