368 East Riverside Drive #8, St. George Utah 84790 UT
833-446-3733
RECEIVE LIFE-CHANGING TREATMENT
You create a life you love — with action!
Please complete the 3 steps in this form.
Step 2 - Complete this Form
Step 3 - Answer the following questions:
Suicidal Tendencies
Yes
No
Depression
Anxiety
Substance abuse
Ever been treated for depression
Ever been treated for substance abuse
Ever been diagnosed with MDD or Mild Depression
Currently seeing a psychiatrist or doctor for depression
Any antidepressant medications
Your information will never be shared or sold to anyone outside of Zion Healing Center.
Robert Beatty
Owner
Information entered will never be shared with anyone outside of Zion Healing Center.