Exit this survey Putting The Pieces Together - Review Copy Request Question Title * 1. I have read approximately ___ books relating to Borderline Personality Disorder. 0 1-3 4-7 8-10 11+ Question Title * 2. I (or my office) generally recommend the following books to patients/consumers dealing with Borderline Personality Disorder: [check all that apply] "I Hate You, Don't Leave Me" - Jerold J. Kreisman "Lost In The Mirror" - Richard Maskovitz "The Angry Heart" - Joseph Santoro "Eclipses" - Melissa Thornton "Borderline and Beyond" - Laura Paxton "Stop Walking On Eggshells" - Paul T. Mason "Life at the Border" - Leland M. Heller "Through the Looking Glass" - Dana Becker "Women and Borderline Personality Disorder" - Janet Wirth-Cauchon "Sometimes I Act Crazy" - Jarold J. Kreisman "Get Me Out Of Here" - Rachel Reiland "New Hope for People with Borderline Personality Disorder" - Neil R. Bockian "The Borderline Personality Disorder Survival Guide" - Alex Chapman "The Dialectical Behavior Therapy Skills Workbook" - Matthew McKay Other (please specify) Question Title "Putting The Pieces TogetherA Practical Guide To Recovery From Borderline Personality Disorder" ~ by Joy A. Jensen Question Title * 3. I am requesting a review copy of "Putting the Pieces Together" for: a governmental (city, county, state) agency. a private practice office. an HMO-sponsored office (such as Kaiser.) a hospital. Other (please specify) Question Title * 4. I (or my office) generally ______ refer patients/consumers to online self-help groups, discussion boards, forums, websites. do do not Question Title * 5. To where should the review copy of "Putting the Pieces Together" be sent? Name: * Company: Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: * Phone Number: Question Title * 6. I would like: to be contacted about other BPD-related issues or topics. to provide signed copies of "Putting the Pieces Together" for my patients. to have the author of "Putting the Pieces Together" speak to my patients/consumers at a conference or on a live web-chat. to purchase a copy / multiple copies of "Putting the Pieces Together." to partner with BPDRecovery.com on a grant proposal, application, project or study. to partner with BPDRecovery.com to produce and/or facilitate a series of online BPD recovery-oriented workshops. to share a voluntary research study with BPDRecovery.com members. to be removed from the mailing list. Other (please specify) Done