Please assist us with obtaining feedback on the needs of our community! 

This is an anonymous survey that will assist us with improving our scope of services.

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* 1. Which service type do you feel is helpful to your family?  Please check all that apply.

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* 2. Do prefer in-home services where a Phoenix staff member comes to your home, or do you prefer to receive services elsewhere?

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* 3. Do you have a reliable vehicle and funds to drive to and from an appointment?

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* 4. Do you prefer to be seen by a female therapist or a male therapist?

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* 5. How old are you?

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* 6. Which county do you reside?

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* 7. If you were required to pay out of pocket for therapy would you be able to afford the following:

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* 8. Optional:  What gender do you identify as.

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* 9. Optional:  What demographic do you identify with?

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