Survey

1. 
Who are you taking this assessment for?

2. 
How long have you been suffering from depression?

3. 
How did you hear about Dreamwork Infusion and Wellness Center's Ketamine Infusion Therapy?

4. 
Have you ever been diagnosed with major depressive disorder, bipolar, schizophrenia, or other psychiatric illnesses?

5. 
How many antidepressant medications have you tried?

6. 
Are you familiar with ketamine infusion therapy?

7. 
Are you now or have you been in counseling?

8. 
Has your doctor ever used medications other than antidepressants to help you feel better?

9. 
Do you use any recreational drugs other than marijuana?

10. 
Please Tell Us About Yourself

11. 
Age

12. 
Do you have insurance?

13. 
How soon are you looking to take care of your depression?

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