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* 1. What is your gender?

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* 2. What is your age?

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* 3. Do you support a Mental Wellness & Addiction Recovery program in Lyons?
Please answer Yes or No.
Why do you feel this way?

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* 4. Considering your needs, and the needs of your friends and family, which counseling services do you feel would be most helpful? Check all that apply.

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* 5. Have you participated in counseling, therapy, or mental wellness programs in the past?

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* 6. If you have participated in services before, which programs have worked in the past? What types of services and/or techniques has helped the most?

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* 7. Are there any barriers that would prevent you from participating in mental wellness or addiction recovery programs provided by LEAF in Lyons?

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* 8. If you were to participate in counseling, what goals of therapy would fit your needs? Check all that apply.

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* 9. In regards to payment for services, which payment options are available to you?

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