This is a questionnaire intended for people who experienced one or more neurological or psychiatric symptom(s) related to montelukast sodium (also known as Singulair, Apo-Montelukast, Auro-Montelukast, Dom-Montelukast, Jamp-Montelukast, Mylan-Montelukast, Teva- Montelukast, Ag-Montelukast, Ach-Montelukast, Montenaaf, Montelon-10, Montene, Montair-10, Montelo-10, Monteflo, Tukast L, Reversair, Miralust, Montiva, Provair, Montril, Lumona, Lumenta, Arokast, Trilock, Ventair, Montika, Montelair, Zykast, Notta, Topraz, AirOn). Although the medication will be called “montelukast” throughout the entirety of the questionnaire, this term refers to any of the drugs listed above.
If you are filling out this questionnaire for someone else, "you" in the questionnaire will refer to that person.
Please note that if you would like to fill out this questionnaire on behalf of more than one person, we ask that you complete a separate questionnaire for each person. If you would like to complete a separate questionnaire, please send an email request to the following address:
MonARCh@recherche-ste-justine.qc.ca
This questionnaire should take you about 30 minutes to complete. Please fill it in its entirety and to the best of your knowledge.
****IMPORTANT MESSAGE****
If you or someone you know are experiencing suicidal thoughts or feelings or if you feel you or they are at risk of these thoughts or feelings, it is important that you seek help.
· Within Quebec, you can call 1-866-277-3553 (1-866-APPELLE) · You can also visit, https://www.aqps.info/besoin-aide-urgente/liste-centres-prevention-suicide.html
· Within Canada : Call Crisis Services Canada at 1-833-456-4566 or visit http://www.crisisservicescanada.ca
· Within the USA: Contact the National Suicide Prevention Lifeline at 1-800-273-8255 or visit https://suicidepreventionlifeline.org/help-yourself/youth/”
· Internationally: Visit https://www.iasp.info/resources/Crisis_Centres/ for information about local crisis centers.
Please note that the information is not automatically saved. If you want to stop the questionnaire before ithe end and continue later, please select the option''Resume later'' which will display in the upper right corner throughout the questionnaire. Your email will be requested and a link will be sent to you with your saved information.
