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Intake form
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Name
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What is your age group?
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Under 18
18-24
25-34
35-44
45-54
55-64
65 and over
What topics are you interested in?
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Men's Mental Health
Trauma Recovery
Advocacy
Public Speaking
Spiritual Development
Support Systems
How did you hear about us?
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Social Media
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What type of support are you seeking?
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Counseling
Workshops
Public Speaking Engagements
Community Events
Resources and Materials
Do you prefer in-person or online interactions?
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In-Person
Online
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