100% of survey complete.

* 1. What is your full name?

* 2. Please write the complete agency name and address where you provide counseling services.

* 3. Please check all the types of sessions you have available.

* 4. Please indicate the preferred phone number for clients to schedule appointments.

* 5. What current, professional licenses do you hold?

* 6. Please describe your fees per session, length of visits, and if you provide a sliding fee scale.

* 7. What is the average wait for 1st appointment?

* 8. Please describe all types of insurance and payments you accept.

* 9. Please indicate your areas of competency

* 10. Please describe your training and work with individuals and families impacted by Alzheimer’s disease or other dementia's.

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