If not, please attach a picture on this form
Who is this appointment for?
If you’re experiencing severe symptoms that might be related to your medication, call 911 or go to the nearest emergency room. If you need crisis support at any time, please call the Spring Health Crisis Line by dialing 1 (855) 629-0554 (choose option 2). Severe symptoms can include, but is not limited to: chest pain, sudden hives, significant stiffness in muscles, sudden high fever, loss of speech, significant uncontrollable shaking.
Please enter all relevant details here
