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Tell Us About You and Your Practice
Your Name
Your Title
Email
Practice Name
Which of the following describes your practice?
Outpatient Clinic
Residential Treatment Center
Partial Hospitalization Program (PHP)
Intensive Outpatient Program (IOP)
Psychiatric Hospital
Substance Use Treatment Facility
Certified Community Behavioral Health Clinic (CCBHC)
Specialized Clinic
Other (Specify Below)
Number of Clinicians
Solo Provider
2-9
10-20
21-50
50+
Any other information we should keep in mind about your practice?
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