Briefly describe your experience with domestic violence and any present symptoms you are experiencing (ex. anxiety, panic, depression, anger)
Are you willing to sign a release of information so that we can speak to this provider, in order to coordinate care?
How would you describe your physical health? (ex. how often do you exercise, do you have any medical issues that exclude you from physical activities)
We've copied your review, after you click 'Publish' please paste your review by selecting 'ctrl' + 'v' into the review comments section.