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Location: Central London
Location: Central London
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Eligibility check for formal assessment.
Full Name
*
Date of Birth
*
Email
*
Contact Number
*
Your Location
*
Gender
*
Female
Male
Pregnancy
N/A
Yes
No
Presence of electronic implants (e.g. cochlear implant, pacemaker, insulin pump, clips)
Have ever had complication from an MRI?
No
Yes
Condition enquiring for.
*
Description of Symptoms
*
Medication Taken?
*
Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine
Fluvoxamine
Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
Bupropion
Amitriptyline
Mirtazapine
Trazodone
Vortioxetine
Aripiprazole
Vilazodone
Phenelzine
None
Other Medications Taken? (if not listed above)
History of epileptic episode?
*
Yes
No
Suffering from insomnia
*
Yes
No
Suffering from migraine?
*
Yes
No
When do you prefer your treatment to start?
Asap
Within 4 weeks
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