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Appointment Questionnaire
Please answer the following to receive an appointment:
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Please list your full name and age
Your answer
Please list your email and phone number
Your answer
Please list your symptoms
Your answer
Please list your health insurance and state of residency
Your answer
What psychiatric medications are you currently taking?
Your answer
Do you need any controlled medications such as xanax, klonopin, Adderall, Concerta, or Vyvanse?
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No
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