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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

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.

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