Hydrocodone Online Questionnaire

June 20, 2011

Hydrocodone is a drug derived from opium and provided to an individual against a valid prescription. Hydrocodone online questionnaire is prepared for online purchase of this drug, as the customer has to answer to a questionnaire that would enable him to buy the drug. Such a questionnaire has to be easy to understand and the language should be very fluid.  Through this questionnaire purchasing or selling becomes easy as this is a kind of drug which is not given to people without a valid prescription.

Sample Hydrocodone Online Questionnaire

Name: ____________________________________

Age: __________

Sex: ____________

Date: ____________

Please answer the questions given below, in brief:

1)   What is the disorder or disease that you are suffering from?


2)   When you were first diagnosed with this disease?


3)   Who is your supervising physician at present?


4)   Did you consult any other physicians before this?


5)   What other medications has the physician prescribed you?


6)   Have you taken hydrocodone before this?


7)   If yes, for how long have you been undergoing this medication?


8)   Have you experienced any side effects like blood disorders, acute emesis, euphoria, nausea, sweating after taking this drug?


9)   Do you consume more than three helpings of alcoholic beverage?


10)               Do you take acetaminophen or Tylenol?


11)               Did you ever suffer from cirrhosis of liver?


12)               Do you suffer from emphysema, asthma or any other respiratory diseases?

Please mention the onset date of any medical complication along with its complications.


Download  Hydrocodone  Online Questionnaire in Word Format



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