Community Survey

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* 1. What is your Zip Code?

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* 2. Would you prefer to go to a counselor in your neighborhood?

In my neighborhood

Outside of my neighborhood

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* 3. Do you know of any counseling services offered in your neighborhood?

Yes

No

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* 4. Have you received counseling at Saint Louis Counseling in the past?

Yes

No

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* 5. If you have received services at Saint Louis Counseling how would you rate your experience?

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* 6. What is your preferred method of contact?

Mail

Email

Phone

Text Messaging