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OTP Intake Survey

OTP Intake Survey

Hi there, please complete this quick survey about your Intake experience. It should take 1-2 minutes to complete.
17Questions
  • 1
    Please Select
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    • California
    • Georgia
    • Indiana
    • Kentucky
    • New Jersey
    • North Carolina
    • Ohio
    • Pennsylvania
    • Virginia
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  • 2
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    • Aegis - Atascadero
    • Aegis - Auburn
    • Aegis - Bakerfield 21st Street
    • Aegis - Bakerfield Columbus
    • Aegis - Bakersfield Truxton
    • Aegis - Banning
    • Aegis - Barstow
    • Aegis - Ceres
    • Aegis - Chico
    • Aegis - Delano
    • Aegis - El Monte
    • Aegis - Eureka
    • Aegis - Fresno
    • Aegis - Grass Valley
    • Aegis - Hesperia
    • Aegis - Inglewood
    • Aegis - La Miranda
    • Aegis – Lodi
    • Aegis - Los Banos
    • Aegis - Madera
    • Aegis - Manteca
    • Aegis - Marysville
    • Aegis - Merced
    • Aegis - Modesto
    • Aegis - Ontario
    • Aegis - Oxnard
    • Aegis - Pasedena
    • Aegis - Placerville
    • Aegis - Pomona
    • Aegis - Redding
    • Aegis - Redlands
    • Aegis - Ridgecrest
    • Aegis - Roseville
    • Aegis - San Luis Obispo
    • Aegis - Santa Barbara
    • Aegis - Santa Maria
    • Aegis - Santa Paula
    • Aegis - Simi Valley
    • Aegis - Sonora
    • Aegis - Stockton 5th St
    • Aegis - Stockton California St
    • Aegis - Stockton Lower Sacremento
    • Aegis - Tracy
    • Aegis - Turlock
    • Aegis - Ventura
    • Aegis - West Covina
    • Aegis - Wilmington
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  • 3
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    • HealthQwest - Buford
    • HealthQwest - Canton
    • HealthQwest - Douglasville
    • HealthQwest - Macon
    • HealthQwest - Savannah
    • HealthQwest - Stockbridge
    • HealthQwest - Warner Robins
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  • 4
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    • Martinsville Treatment Services
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  • 5
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    • Please Select
    • Carrollton Counseling
    • Davis Treatment Center
    • Georgetown Medical
    • Maysville Medical
    • NKY Med Clinic
    • Simpson Treatment Services
    • Western KY Medical
    • Winchester Treatment Services
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  • 6
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    • Delaware Valley Medical
    • Hamilton Treatment Services
    • Lacey Treatment Services
    • Middletown Medical
    • Ocean Medical Services
    • Ocean Monmouth Care
    • Somerdale Treatment Services
    • Stateline Medical
    • Trenton Treatment Services
    • Vineland Treatment Services
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  • 7
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    • Please Select
    • Stepping Stone of Boone
    • Stepping Stone of Wilkes
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  • 8
    Please Select
    • Please Select
    • Akron Treatment Services
    • Athens Treatment Services
    • Brilliant Treatment Services
    • Chillicothe Treatment Services
    • Covedale Treatment Services
    • Dayton Treatment Services
    • Elyria Treatment Services
    • Findlay Treatment Services
    • Georgetown Treatment Services
    • Hamilton Treatment Services
    • Marion Treatment Services
    • Niles Treatment Services
    • Sandusky Treatment Services
    • Springfield Treatment Services
    • Toledo Treatment Services
    • Youngstown Treatment Services
    • Zanesville Treatment Services
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  • 9
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    • Alliance Medical Services - Johnstown
    • Alliance Medical Services of Pittsburgh - Ensign I
    • Alliance Medical Services of Pittsburgh - Ensign II
    • Charleroi Treatment Services
    • Greenfield Counseling
    • Hanover Treatment Services
    • Hazleton Treatment Services
    • Lansdowne Treatment Services
    • Miners Medical
    • Mount Pocono Medical
    • Northeast Family Healthcare
    • Pinnacle Treatment Services of Aliquippa
    • State College Medical
    • Summit Medical Services
    • Williamsport Family Medical
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  • 10
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    • American Addiction Treatment Center - Hayes
    • American Addiction Treatment Center - Newport News
    • American Addiction Treatment Center - Williamsburg
    • Culpeper Treatment Services
    • FCCR - Fredericksburg
    • FCCR - Radford
    • FCCR - Southlake
    • Front Royal Treatment Center
    • Martinsville Treatment Services
    • Pulaski Medical
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