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Intake questionnaire

RE104 Safety and Efficacy Study in Adjustment Disorder in Cancer and Other Medical Illnesses

Applying to Providence Medical Foundation · Santa Rosa, California

Answer a few short questions to share with the research team.

0 of 4 answered

1. Are you between 18 and 80 years old?
2. Have you been diagnosed with Adjustment Disorder?
3. Are you currently pregnant or breastfeeding?
4. Are you able to travel to Santa Rosa for study visits?