Before And After forms
HARMED Hearts • Harmed.LifeSpouses & loved ones exposing the truth Big Pharma tries to hide.
HARMED Hearts
Before & After Medication — Loved Ones Worksheet
Use this worksheet to show observable changes. Rate what you witnessed before medication versus during/after (including taper/withdrawal). Check any cues that apply and add examples.
Comparison — Before vs During/After
Scale: 1 = Very Low • 3 = Typical • 5 = Very High
| Area (observed) | Before (1–5) | During/After (1–5) |
|---|---|---|
| Personality (overall consistency) | 1 2 3 4 5 | 1 2 3 4 5 |
| Empathy (ability to feel with others) | 1 2 3 4 5 | 1 2 3 4 5 |
| Warmth (affection, kindness, intimacy) | 1 2 3 4 5 | 1 2 3 4 5 |
| Emotional range vs. blunting | 1 2 3 4 5 | 1 2 3 4 5 |
| Patience (ability to tolerate stress) | 1 2 3 4 5 | 1 2 3 4 5 |
| Irritability (short fuse, anger) | 1 2 3 4 5 | 1 2 3 4 5 |
| Motivation / drive | 1 2 3 4 5 | 1 2 3 4 5 |
| Energy / fatigue | 1 2 3 4 5 | 1 2 3 4 5 |
| Sleep quality | 1 2 3 4 5 | 1 2 3 4 5 |
| Anxiety / panic | 1 2 3 4 5 | 1 2 3 4 5 |
| Depression severity | 1 2 3 4 5 | 1 2 3 4 5 |
| Suicidal thoughts/behavior | 1 2 3 4 5 | 1 2 3 4 5 |
| Aggression / violence | 1 2 3 4 5 | 1 2 3 4 5 |
| Paranoia / suspicion | 1 2 3 4 5 | 1 2 3 4 5 |
| Impulsivity / risk-taking | 1 2 3 4 5 | 1 2 3 4 5 |
| Alcohol / substance use | 1 2 3 4 5 | 1 2 3 4 5 |
| Memory / focus | 1 2 3 4 5 | 1 2 3 4 5 |
| Judgment / financial decisions | 1 2 3 4 5 | 1 2 3 4 5 |
| Sexual function / libido | 1 2 3 4 5 | 1 2 3 4 5 |
| Weight / appetite | 1 2 3 4 5 | 1 2 3 4 5 |
| Social withdrawal / isolation | 1 2 3 4 5 | 1 2 3 4 5 |
| Spirituality / conscience | 1 2 3 4 5 | 1 2 3 4 5 |
HARMED Hearts
Before & After Medication — Loved Ones Worksheet (continued)
Observable Cues (check any that apply)
Examples / Notes
Key Events & Timeline (dates, dose changes, crises, hospitalizations)
Loved one’s signature (optional)
Reporter’s signature
Date
