Survey Name
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1. 2. 3. Highest Degree Received: 5. Licensure: Please check all that apply: Years of post-graduate experience: Current Practice Setting: 9. Professional Self-View: Primary Theoretical Orientation: What is your secondary theoretical approach used most often? 13. Are you participating in a peer consultation group? 15.If participating in a peer consultation group, what types of activities do you participate in? Please check all that apply. 16.Estimated hours per week devoted to designated activites: 17.Please list any other activites and hours devoted to them, if not listed above: 18.Please indicate what type and how many hours/week are devoted to the following counseling/therapeutic activites? Estimated hours /week devoted to informal or formal research activites: How do you evaluate the effectiveness of clinical interventions and/or clinical outcomes? What percentage of your clients receive medicaid funding for their mental health care? How long have you been an approved provider for a managed care company? 23.Please indicate to what degree you agree or disagree with the following statments: 24. 25. 26. 27. 28. |