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Client Intake & Consent form
Must be completed prior to session

Multi-line address
Birthday
Month
Day
Year
Date
Month
Day
Year

By submitting this form, you confirm that all information is accurate and that you have read and agreed to the consent statements above. After you submit this form, I will reach out to you for scheduling.

I will reach out to you after you submit the form to book your appointment and discuss payment.  Payments are in advance

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