Dallas Group Analytic Practice

Bob Bennett, MD,CGP,FAPA ·   Melissa Black, PhD,CGP
Dale C. Godby, PhD,CGP,ABPP  ·   Myrna Little, PhD,CGP
Scott Nelson, PhD, CGP

  6330 LBJ Fwy, Suite 150, Dallas, TX 75240
972-392-4155


Add Personal Profile

First Name Middle Initial
Last Name
Degree
D.O.B. (MM/DD/YY)
Sex
E-mail*     *required
Address Line 1
Address Line 2
City State/Province
Zip Code
Country
Requests for mailings
Updates on DGAP Activities
Continuing Education
DGAP Brochures
Your Business Your Programs
Public Hospital Child
Private Hospital Adult
Mental Health Ctr Adolescent
Clinic Seniors
Private Practice
Other

 

Your Services Your Specialties
Inpatient Child
Outpatient Adolescent
Partial Hospital Adult
Rehabilitation Seniors
Residential Marriage & Family
Other
 Substance Abuse
Sexual Dysfunction
Eating Disorders
Addictions
Other
Costs of Services
Primary Referral Source
If other, please specify
Primary Treatment Philosophy
If other, please specify
Managed Care Contracts
Have you referred a patient to DGAP? Yes   No
Would you like to visit DGAP for a professional lunch seminar any Thursday 12-1? Yes   No
Would you like to be contacted by a referral development specialist at DGAP? Yes  No
(If yes, please fill out the following.)
Contact Phone Number
Preferred Contact Time

 

bbar.gif (2270 bytes)