Benzodiazepine Survey Three - Recovered
Answers marked with a * are required.
 
1. What benzodiazepines or Z-drugs were you  taking at the time you decided to withdraw? *

























      
 
 
 
2. How long had you been taking benzodiazepines or Z-drugs at the time you decided to withdraw? *












      

 
 
 
3. If you were only taking one benzodiazepine or Z-drug at the time you decided to withdraw, enter the number of milligrams per day you were taking.
 
 
 
4. If you were taking more than one benzodiazepine or Z-drug at the time of deciding to withdraw, enter the name of each of the drugs that you were taking, followed by the number of milligrams you were taking, e.g. Valium 30, Klonopin 2.
 
 
 
5. Why were you prescribed benzodiazepines or Z-drugs? *





      
 
 
 
 
 

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