Spravato Assessment - Is Spravato Therapy right for me?
How soon are you looking to take care of your depression?
As soon as possible
Within the next 3 months
Have you ever been diagnosed with Major Depressive Disorder (MDD)?
Have you been diagnosed with Treatment-Resistant Depression?
Have you had suicidal thoughts in the past year?
How many antidepressant medications have you tried?
4 or more
Have you ever been diagnosed with Bipolar, Schizophrenia, or other psychotic illnesses?
Yes, but I may have been misdiagnosed
Have you tried therapy, counseling, or coaching?
Yes, it has helped me
Yes, I have tried with insufficient benefits
Yes, but I stopped going because it wasn't working and/or I didn't like it
No, I have never tried it
Have you heard about Spravato Nasal Spray for Depression?
How did you hear about Spravato Nasal Spray for Depression?
Evolve Health Website
My Doctor or Health Care Provider
Friend or Family Member
Who are you taking this survey for?
Have you abused any of the following substances in the past 12 months?
Tobacco / Nicotine
More than one of these
None of these
Do you currently use any other recreational drugs other than Marijuana?
No, I used to but I stopped
No, I have never tried any
What is your gender?
Rather not say
Do you have health insurance?
Which insurance do you have?
Blue Cross Blue Shield (BCBS)
What is your age?
65 or older
First Name (Press Enter after entering information)
Last Name (Press Enter after entering information)
Phone (Press Enter after entering information)
Email (Press Enter after entering information)
Which clinic location is nearest you?
Las Vegas, NV