Feedback Form - 30-day Free 7-Session Teen Online Program

Thank you for taking the time to evaluate the 7-Session Teen Online Program. We would sincerely appreciate if you could share with us details of your experiences by filling out the form fields below. 

Name *
Name
Phone *
Phone
Did you complete all sessions of the program? *
Do you plan on using the online COPE Program? *
What was your overall impression of the program in terms of how helpful it would be to your patients or students? *
Would you like us to contact you with details on how to order the program? *