Contact Mental Health Advocates

For more information, please call us at 561-368-8430, email Dr. Saltz at brucesaltz@aol.com. Or print this form and fax it to us at 561-362-5575.


Name

Address

City / State / Zip

Home phone

Email

Consumer

I am interested in treatment for: Myself Marriage Family member Other (write in below)

My biggest concern is...

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Professional

I am a (choose one): Physician Psychologist Nurse Social Worker Other (write in below)

I am interested in (select all that apply): Referring a patient for treatment. CME VHS or CD-ROM orders. Reliability training. Use of the Extrapyramidal Side Effect Rating Scale (ESRS) or Abnormal Involuntary Movement Disorder Scale (AIMS) for pharmaceutical company multicenter trials. Clinical trials.

The best time to call me is

The number to use is