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Application Form
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Full Name
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Email
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What are your current credentials in the states that you are licensed?
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What states are you licensed in?
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What client populations are you interested in, and do you have a specific niche or specialty that you focus on?
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What age range are you interested/wanting to work with?
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Young Adults (18-24)
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How many clients would you like to see a week?
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What is your ideal work schedule?
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How did you learn about our practice?
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What are you looking for in a group practice?
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