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Health Intake Form & Informed Consent

Client Intake & Informed Consent Form

    In the First and Last Name boxes below, enter the name of the client (the person or child who has the health issue). We will use this one name for all your records. Please use this name in all your communications.

    If you're filling this out for the client, only place your name in the box labeled, "If you are not the client, what is your name?"

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    Not valid on professional or on sale classes