Hello! Thanks for taking a few minutes to respond to this survey about the telehealth services that you are receiving. Your feedback is very important to us. Your responses will be anonymous unless you would like to have them be associated with your name.

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* 1. Where did you have your in person services before you started telehealth?

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* 2. What non-residential service do you primarily receive from this agency?

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* 3. Please select your age group:

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* 4. What race/ethnicity do you primarily identify yourself as:

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* 5. What is the primary form of "Telehealth” that you receive from this agency?

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