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Impeachara®
Elect to be happy.
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Get a prescription for Impeachara®
Name
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First Name
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Please tell me about your T.I.A.D.
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SYMPTOMS
Please rate...
I FEEL DEPRESSED
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I FEEL HOPELESS
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I HAVE TROUBLE SLEEPING
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I'M HAVING FREQUENT ARGUMENTS WITH FAMILY & FRIENDS
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I FIND MYSELF YELLING AT MY PHONE OR COMPUTER SCREEN
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Prescription has been filled.