Contact and Referral

Please fill in the form below if you are interested in participating in any of the studies or if you have any questions about any of the studies.

Full Name *

Phone Number *

Email *

Age

Sex

Do you have a family physician? Name of family physician:

Were you diagnosed with psychiatric disorders? Which ones?

Please select the study you are interested in:

• Trigeminal nerve stimulation in treatment-resistant generalized anxiety disorder: a feasibility study
• Adjunctive Treatment with L-methylfolate for Treatment-Resistant Generalized Anxiety Disorder: a Pilot Study

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Please fill in the form below if you are interested in referring one of your patients to any of the studies. Please note that the referral form should be filled only by physicians.

Name of Referring Physician * Phone Number of referring physician: * Email Address of referring physician: * CPSO number: * Billing number: * Study: * Trigeminal nerve stimulation in treatment-resistant generalized anxiety disorder: a feasibility study Adjunctive Treatment with L-methylfolate for Treatment-Resistant Generalized Anxiety Disorder: a Pilot Study Consent was obtained for this referral? Verbal or written? * Full name of patient: * Phone Number for patient: * Email Address for patient: * Principal diagnosis: Psychiatric comorbidities: Recreational substance use (includes alcohol)? Which one? Medical comorbidities: Message Submit