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ARE YOU TIRED OF SUFFERING WITH DEPRESSION DAY IN AND DAY OUT?

Who are you taking this assessment for? *

Myself

My Spouse

A Sibling

A Parent

A Different Loved One

How long have you been suffering from depression? *

Less than 2 weeks

1 - 6 months

6 - 12 months

1 - 2 years

2 - 4 years

More than 4 years

How did you hear about Allay Health and Wellness's Ketamine Therapy? *

The Doctors

Facebook / Google

Radio

Mayo Clinic

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

Yes

No

How many antidepressant medications have you tried? *

None

1 - 2 medications

3 - 4 medications

4 or more medications

Are you familiar with Ketamine Infusion Therapy? *

No, I have never heard of it

I have heard of it briefly and am interested in treatment

I am very familiar with it and would like to set up a phone consultation to learn more

Are you now or have you been in counseling? *

Yes, I am currently undergoing counseling

Yes, I have tried it and failed

Yes, but I stopped going because it wasn't working / I didn't like it

No, I have never tried it

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

Yes, I have tried Xanax, Abilify, Adderall, Lamictal, or other medications

No, I have only tried antidepressants

Do you use any recreational drugs other than marijuana? *

Yes, occasionally.

I used to, but stopped.

I never tried any.

Please Tell Us About Yourself *

Male

Female

Age *

18-24

25-49

50-64

65 & Older

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

Right now!

As soon as possible

This week

This month

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Last Name *

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Depression Relief IS Possible At Allay Health and Wellness!

That’s why we want you to take part in our Simple Quiz to REINVENT THE WAY YOU THINK ABOUT DEPRESSION. We want to share our own knowledge accumulated from study and experience and will be glad to hear any questions you have for us.

Allay Health and Wellness

Our mission is to provide a better way to live for those who are dealing with emotional and physical pain. We provide cutting edge treatment that is showing major benefits to this struggling with treatment-resistant depression, mood disorders, chronic pain. We want to be the starting point of your recovery.

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Allay Health and Wellness

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