Intake form

In order to participate in Clinical Research Study, please fill the INTAKE FORM in advance. Confidential information are protected by law.

MDC_Intake_Form 2019 (docx)


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If you are interested in more information or having any questions about our Tourette’s Clinical Trial,  please also feel free to send us a message and we will get back to you in 48 hours.

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Mood Disorders Consulting Medicine, PLLC

2 West 46th Street, Manhattan, New York, New York 10036, United States

Call: +1 646-838-5111 Email: Recruitment Fax: +1 646-838-5181


Monday - Friday: 9AM–5PM

Saturday - Sunday: Closed

Emergency Service: 24/7