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* 1. Please provide the following information

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* 2. How many hours per week are you interested in seeing clients?

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* 3. I am available to see clients weekly on the following days and between the following hours.

  8am-noon Noon-4pm 4pm-9pm
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

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* 4. If licensed in Virginia as an LPC, LCSW, LMFT, or clinical psychologist

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* 5. Please indicate the ages you are trained and interested in working with.

  Trained & experienced Interested in working with
2-6
6-11
11-18
19-26
Adults
Geriatric

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* 6. Diagnoses Experience & Interests

  Experienced with Would like to work with Plan to take additional training
Anxiety
Depression
Bipolar
Serious Mental Illness
Trauma/PTSD
Childhood trauma
Developmental Disorders
Addictions (Alcohol/ Substance Abuse)
OCD
Eating disorders
Self harm
Life transitions
Geriatric issues
Health issues
Families
Couples
Military Issues
Parenting
Divorce Discernment
Divorce Support

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* 7. Availability to start

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* 8. What aspects or areas of counseling are you passionate about?

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* 9. What areas of counseling are you interested in gaining additional training?

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