Your Name* Your Email* Telephone* Are you taking medication to treat your depression? YesNo Are you still depressed despite your medication? YesNo Are you experiencing side effects from your medication? YesNo Have you switched medications more than once due to side effects? YesNo Are depression symptoms interfering with your leisure activities or relationships with your family and friends? YesNo Are depression symptoms having an effect on your ability to earn a living? YesNo Please leave this field empty.