Account Login

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?"

    Great! Here's a New Subscriber Coupon you can use to get 50% off your entire order!

    Enter Code: SAVE50NOW
    when you check out!

    *Not valid on professional courses

    30% OFF Spring Cleaning Courses for Your Body and Mind!

    Enter SPRINGCLEAN30 at Checkout

    Expires at 11:59pm PT on May 31st. Offer valid on all classes except pro level.