Lifeline Cleveland

Naomi

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Lifeline Cleveland Project Survey

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How did you hear about this site? *

Internet Search Advertisement Friend Other

If Other please specify: *

Name *

First

Last

Email *

Phone Number *

What is your age? *

Less than 13 13-18 19-25 26-35 36-50 Over 50 Prefer not to say

Are you or have you experience struggles with mental health (Select One) *

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How long have you been dealing with mental challenges? *

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