Contact Us Please complete the form below Date MM DD YYYY Time Hour Minute Second AM PM Location Seizure (Y or N) * Yes No Type * Focal Absence Myoclonic Tonic / Atonic Tonic / Clonic / Tonic-Clonic Duration * Rescue Medication Valtoco - Nasal Puff (20mg) Klonopin - Dissolvable Tablet (2mg) Ativan - IV Push Other - See Notes Quantity Addictional Info (250 characters or less) Thank you!
