Do you have a history of any of the following?
Seizure Disorder Stroke Head Injury Brain Tumor Cancer NONE
Please let us know which of the following symptoms you’ve experienced:
Having a lack of emotion Problems paying attention Jumping between unrelated topics Problems expressing ideas Feeling anxious or angry Hearing/seeing things that aren't there False beliefs that are not based on reality NONE
Have you been treated for Schizophrenia before?
Are you currently receiving treatment for Schizophrenia?
Are you over 18?
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TV Radio Referral Flyer/Brochure Internet Search Web Advertisement Facebook Previous Patient
Name (First and Last):
Are you a resident of Washington State?
What is the best time to contact you?
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