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Full Name
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Email
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Phone
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Professional Background
What is your profession?
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Speech-Language Pathologist
Psychologist
Special Needs Teacher
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How much experience do you have working with individuals with special needs?
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Less than 1 year
1-3 years
3-5 years
5+ years
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Do you currently work with clients, students, or patients who would benefit from video modeling therapy?
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How do you plan to share your referral link?
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Email
Social Media
Word of Mouth
Website/Blog
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