FOR PROVIDERS

We want to learn from you! To gain a better understanding of what is important to you, please check any topics of interest. If you prefer a downloadable .pdf of this form click here.

Provider Name:*

First

Last

Specialty: *

Provider State:*

I treat Women Of Childbearing Years:

Frequently

Infrequently

I screen for depression before, during and after pregnancy:

Frequently

Infrequently

I treat children and adolescents:

Yes

No

I Would Like:*

To learn about the difference between EnBrace HR and other prenatal vitamins.

To learn about the MTHFR polymorphism gene defect and how it relates to pregnancy/birth complications.

To learn about new research in progress on EnBrace HR for MDD relapse prevention in women trying to conceive.

To learn more about the Homocysteine Theory of Depression.

A list of risk factors that deplete folate.

To be invited to a brief discussion with a key opinion leader.

To speak with the inventor of EnBrace HR.

Information on the link between antidepressants & autism.

To learn more about methylation & elevated homocysteine.

To learn more about cost savings options for EnBrace HR.

To receive Patient Brochures for my office.

To receive Spanish speaking literature.

other

Please Tell Us More Here:

Please provide the best contact number and email address.*

Area Code

-

Phone Number

E-mail:*

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