Counseling Resources
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1
. What is your full name?
What is your full name?
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2
. Please write the complete agency name and address where you provide counseling services.
Please write the complete agency name and address where you provide counseling services.
3
. Please check all the types of sessions you have available.
Please check all the types of sessions you have available.
Daytime appointments
Evening appointments
Weekend appointments
Individual Sessions
Couples Sessions
Family Sessions
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4
. Please indicate the preferred phone number for clients to schedule appointments.
Please indicate the preferred phone number for clients to schedule appointments.
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5
. What current, professional licenses do you hold?
What current, professional licenses do you hold?
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6
. Please describe your fees per session, length of visits, and if you provide a sliding fee scale.
Please describe your fees per session, length of visits, and if you provide a sliding fee scale.
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7
. What is the average wait for 1st appointment?
What is the average wait for 1st appointment?
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8
. Please describe all types of insurance and payments you accept.
Please describe all types of insurance and payments you accept.
9
. Please indicate your areas of competency
Please indicate your areas of competency
AD/Dementia
Grief/Loss
Caregiving
Chemical Dependency
Depression
Family mediation
Family Violence
Geriatrics
Sandwich Generation
Other
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10
. Please describe your training and work with individuals and families impacted by Alzheimer’s disease or other dementia's.
Please describe your training and work with individuals and families impacted by Alzheimer’s disease or other dementia's.
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