Survey – Doctor Green

Survey

1. Have you previously spoken to a doctor about your condition, and have your symptoms been present for three months or longer?*

Yes

2. Have you previously tried any treatments for this condition?*

Yes

3. Did previous treatments fail to provide full relief or cause unwanted side effects?*

Yes

4. Do you have a personal or family history of psychosis, schizophrenia, or bipolar disorder (type I or II)?

Yes

THANK YOU FOR SUBMITTING!

WE’VE RECEIVED YOUR FORM. OUR CLINICAL TEAM WILL REVIEW YOUR RESPONSES, AND YOU’LL HEAR FROM US WITHIN 24 HOURS REGARDING YOUR ELIGIBILITY.

TO ENSURE WE CAN GET BACK TO YOU, PLEASE MAKE SURE YOU’VE ADDED YOUR EMAIL ADDRESS.

Email Address