Have you been formally diagnosed with depression?
Has a healthcare professional told you that you have social anxiety disorder?
If yes, when did you last feel suicidal?
Feel free to leave this section blank if you did not feel suicidal.
Any previous experience with ketamine, ketamine derivatives, ECT, TMS, or vagal nerve stimulation?
Do you currently take any psychotropic medication like benzodiazepines or SSRIs such as clonazepam (Klonopin), alprazolam (Xanax), or Zoloft?
Have you had minor bariatric survey within the last 2 years?
Are you on any mood stabilizers or stimulants?