Fill out the form below to see if you qualify.
First Name*
Last Name*
Email*
Phone Number*
Have you been diagnosed with Schizophrenia?
Do you hear voices? yesnoI have in the past
Do you think that people are plotting against you or spying on you? yesnounsure
Have you ever felt that people on the TV or Radio were specifically talking to you? yesnounsure
Do you see things other people can’t see? yesnounsure
When was the last time you were hospitalized?
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