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QUESTIONS FOR A FASAP CLINICIAN FORM


PLEASE NOTE:

This website and the forms submitted via the internet are NOT SECURED. Thus, we strongly suggest that you should not submit any confidential information using these forms or email.

Keeping this in mind however, if you would like a personal reply to your feedback form, you must provide your name and either a phone number, an email address, or an office address, as these forms do not identify from whom or where the form is sent.

Furthermore, because we cannot guarantee a timely response to your inquiry, all emergencies and time-sensitive issues should be processed through the general FASAP contact numbers (443-997-7000 or 443-287-7000), the psychiatric resident in the Emergency Room (410-955-5964), or the Emergency Room nearest you.

Name:
Phone Number:
Email:
Once again, please read the notice above before submitting your question form.

If a personal response is requested, a FASAP clinician will attempt to reply within one week, provided your contact information is provided.

Thank you for taking the time to complete this card.


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