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Psychiatry Clinic Interest Form
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Name
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Your answer
Phone Number
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Your answer
Some common psychiatric issues/ services are listed below, please select any of the following that you feel should be addressed at the psychiatry clinic:
*
Anxiety
Depression
Substance abuse
Obsessive Compulsive Disorder (OCD)
Post-Traumatic Stress Disorder (PTSD)
Child/adolescent counseling
Eating disorders
Other:
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Additional suggestions or concerns:
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