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1. Please enter information on the child being referred for counseling: First Name: Gender: FemaleMiddle Initials:Last Name:Date of Birth:Street Address: MaleTransgenderCity:State:Apt./Unit #:Nonbinary Zip Code:Home Phone:Email:Preferred contact method: Mobile Phone Home PhoneEmailMobile Phone:What school is your child attending?Child\'s preferred language for counseling? English Spanish Other Client\'s Ethnicity White African AmericanAsianAmerican IndianPacific IslanderOtherClient\'s...
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