General Information Forn
Page 3
Please check yes or ao for each of the following health services
not they are available in a clinic serving area?
the service, its availability, and reliabilicy.
Type of Health Service
No
Optical services
CIC]
Medicines or pharmacy
services
14.
Rehabilitation service
a
bs
‘
+
a
—
Care for the ages
16.
Psychiatry services
17.
Suicide prevenrion services
18.
Alcohol rehabilitation
19.
Alcoholism preventicn
20
Drug abuse rehabilitation
Drug abuse prevention
STD services
Other health services
Yes
s to whether or
If you check ye » Please describe
Nature of Service, Avadlability, Reliabilir