Treatment Report

Since our main goal is to help patients and those who are affected by addiction to quit, we encourage you to submit your treatment report and/or your rehabilitation experience, using Connection to Cosmic Internet.

Hence, if you have requested for the Connection before and improved successfully, you can submit your report and medical documents now. You can briefly tell us about your disease/addiction type, your experience, improvement, and any changes in your heath condition while using Connection. Feel free to choose a nickname if you do not like to use your really name. Your personal information and data will be kept confidential.

Briefly tell us about your treatment/rehabitation experience. If you have any improvement, externalization or report, after using Connection, please briefly explain here.
Click or drag files to this area to upload. You can upload up to 4 files.
Please upload your medical report before and after treatment. These documents might be used for the research purposes. Max File Size 6 MB. (PDF, zip)