MAOI Doctors Form Submission

This form is used to submit MAOI Doctors. Please enter the details of your doctor who prescribed you an MAOI such as Nardil. Once approved, it will be listed here.

Doctors are also welcome to complete this form.

MAOI Doctors Form Submission

If you know a doctor that prescribes MAOI's, please help building this list by adding them here When you ask your doctor about MAOIs it is a good idea to be educated about these medications and understand the diet. This will help you both work together in the same direction. Please note that Doctors are sorted alphabetically by country.

What is your Email address?*

Please note, this will not be displayed on the database. It is only for site admins to contact you if there is an error with your entry or something is unclear.
Are you a patient or a Doctor?*
- Patient
- Doctor
Note: Unless you are a doctor or psychiatrist, please select "patient".
Doctor Name*
First Last
Name of Clinic
Address*
Street Address Suburb City State / Province / Region ZIP / Postal Code Country
Type of Doctor*
- General Practitioner / Family Doctor
- Psychiatrist
Phone*
Email
Website
Were you already on MAOI?*
- Yes
- No
Were you already on this MAOI when you saw this doctor? Yes for getting more or No for getting MAOI for the first time.
Notes
Are you willing to prescribe MAOIs?*
- Yes, to patients not already on one
- Yes, to patients already on one
Such as Nardil or Parnate?
Name
This field is for validation purposes and should be left unchanged.