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How did you hear about us?
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Internet Search
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CommUnity Care Clinic
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Non-Profit or Agency
Other
If other:
*
Living Healthier is a free and confidential hotline that can help you reach your health goals. Would you like to be contacted by a Living Healthier Coach?
*
Yes
No
Please select any of the following services you're currently receiving:
*
Medicaid
Medicare
CHIP
MAP
Sliding Fee Scale
SNAP
WIC
None of the above
For individuals living in Travis County, are you interested in seeing a doctor at a CommUnity Care Clinic?
*
Yes
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Are you the parent/guardian of a child enrolled in ACE, an after school program within AISD?
*
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English
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