Pain & Addiction Expert | Author | Scientist

Lynn R. Webster, M.D.

Please select your gender(Required)

Female

Male

This field is hidden when viewing the form

Do you have a family history of substance abuse? Check all that apply

Alcohol

Illegal drugs

Prescription drugs

Do you have a family history of substance abuse? Check all that apply

Alcohol

Illegal drugs

Prescription drugs

Do you have a personal history of substance abuse? Check all that apply

Alcohol

Illegal drugs

Prescription drugs

Is your current age 16-45 years old?(Required)

Yes

No

Do you have a history of preadolescence sexual abuse?(Required)

Yes

No

Do you have a history of preadolescence sexual abuse?(Required)

Yes

No

Have you been diagnosed with any of the following Psychological diseases? Check all that apply.

Attention Deficit Disorder, Bipolar, Schizophrenia, Obsessive compulsive disorder, PTSD

Depression

Notifications