Qualifying Survey

Answer the short questionnaire below so we have the details needed to help you on your call

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How did you hear about us? *

Internet Search Advertisement Friend Health Professional VAC Case Manager Other

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Have you been diagnosed with PTSD by a medical professional? *

Yes No In progress Other

If Other please specify: *

Have you sought treatment or support for your PTSD in the past? If yes, what types of treatment have you tried? *

Are you currently receiving any form of therapy or counseling? Comment *

What are the main symptoms or challenges you experience due to PTSD?Comment *

Are you available to commit to the program's schedule? *

What are your goals for joining this program? What outcomes do you hope to achieve? *

Are there any specific areas of your life, such as relationships, hobbies, or work, that you'd like to address as part of your recovery journey? *

What is your full name *

What is your email address *

What is your phone number? *

I agree to receiving marketing and promotional materials

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