Registration Form - Oakwood Roots RFPT Consult Groups
Upon completion of this form, you will be contacted by a Roots clinician to complete your registration process. Contact Jeremy Dew, Clinical Director, for any questions at
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LICENSE TYPE, LIC# NUMBER (i.e., LPC, TX #71786, or "graduate student on LPC track")
YEARS IN PRACTICE:
WHAT IS YOUR HOPE IN CHOOSING TO PARTICIPATE IN THIS CONSULT GROUP?
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