Explain reason for todays’ doctors visit:

This is a last resort.

Waking up is a nightmare.

Eyes shut

Blackness spinning

Eyes open

Reality spinning.

A life filled with a blur of doubt

A constant illusion of movement

Never a steady grip on reality.

A wheelchair needed at the age of 16

Not because of a physical imparity

But of weakness

That feels fictitious.

The inception is the deception of life;

And isn’t that supposed to be the truth?

Constantly telling my story on repeat


Check the following symptoms that pertain to incident for the reason for visit: (Check ALL that apply)

-   Dizzy

-   Nausea

-   Migraines

-  Inability to walk

-   Lightheadedness

-   Doubt

-   Hopelessness

-  Anger

-   Discombobulated

-  Anxiety

-   Fear

-   Frustration

-  Lost.

-   Confusion

-   Stress

-   Other. (If checked please explain)


            Life has turned into

            A series of waiting rooms,

            Doubtful doctors,


            And procedures after tests after MRI’s after physical therapy.

            This is a pathetic cry for help.


List all medications currently on or have been on in the last 6 months that pertain to reason for visit:




Basically everything with an ine.




A drug cocktail

So there’s no difference between

Actuality and my reality.


Anything else you would like the doctor to know before seeing him?

Will you be the one

To finally wake me up

From this nightmare?

To give my life back to me?

How can I live my life this way?

Will I ever be better?

Why did I just wake up one day

With this?

With no real cause

Or reason?

Can you give me the reason?


Why me?

Or am I just crazy?




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