Horry County Citizen's Crisis Response: Mental Health & Addiction Professionals Questionnaire
We are building a network of therapists, psychologists, psychiatrists, social workers, and addiction counselors. This form provides us with information about your practice so it can be shared with those in need.
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Name: *
Phone Number: *
Email Address:
Website: *
What is your specialty? *
Are you taking new clients? *
In light of COVID-19, are you able to offer any of the following? *
Required
Do you take insurance? *
Are you offering any special discounts or services in response to COVID-19? *
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