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Professionals section
Last Name *
First Name *
Email for group (this address must be linked to a Google account) *
Preferred email for personal communication (if different)
Location (and nearest major town) *
State/Province *
Country *
MAOI user accepting referrals
Contact Phone (Patient Referrals)
Contact email (Patient Referrals)
Qualification and practice (clinician, clinical researcher, non-clinical research) Pt/t, f/t etc) *
Position and practice *
Professor
Medical Doctor
Consultant
Director/Chair
Researcher/Scientist
Retired
Select all applicable
Institution, Hospital etc.
Areas of special interest *
Decades of experience early/mid/late, semi-rtd, rtd) *
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