This form is not a diagnostic instrument and is only to be used within the context of your medical treatment and by you if you are greater than 18 years old. Share your checklist responses and assessment with your physician or other health care provider. The maker and provider of this form disclaims any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material.

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Your physician will want to see your M3 Assessment Report

After you complete the questions on the screen you will receive a customized analysis that is known as the Assessment Report. This report is based on how your responses compare with the MINI, an internationally accepted standard.

You may want to share the Assessment Report with your treating physician via hard copy, fax, or email. In addition, your Assessment Report may be securely accessed through a Microsoft® HealthVault account.

Your doctor may make use of this information to discuss with you if treatment may be beneficial.

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This form is not a diagnostic instrument and is to be used solely within the context of your medical treatment with your physician or other health care provider. The maker and provider of this form disclaims any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material. WhatsMyM3™ V.03.06 Copyright © 2002-2012 by M3 Information™, The M-3 Checklist and WhatsMyM3.com are free for personal home use. For any other uses, including clinical., educational, non-profit, hospital research, or for-profit settings please contact mail@m-3information.com. No further reproduction or distribution, or reverse engineering is permitted without written permission from M3 Information. Patent Pending.