Beyond Conventional Mental Health Treatment
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First Name
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do Name have?
Last Name
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Business Email
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Phone
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Company
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Job Title
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Do you have a prescriber on staff?
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Choose One
Yes, Psychiatrist
Yes, Nurse Practitioner
No
How many locations do you have?
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Choose One
0
1
2+
Do you currently offer TMS?
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Yes
No
Do you offer interventional psychiatry?
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Yes, including, but not limited to, Ketamine, Spravato
No
Are you a decision-maker at the company?
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Choose One
I am a Decision-Maker
I am an Influencer
No Influence
Which of the following best describes your practice or clinic?
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Choose One
Psychiatry Practice
Interventional Psychiatry Clinic
Ketamine Treatment Clinic
Spravato Treatment Clinic
Outpatient Psychiatry Practice
Medical Wellness Center
Brain Health Clinic
Behavioral Health Clinic
Mental Health Treatment Center
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