Please completely fill out the form below or download the form, print, fill out, and bring with you to your appointment.

[ARForms id=105]

Client Intake Form

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  • Do You:
    (Take-Home information will be given to you at checkout.)
  • I CONFIRM THAT THE ANSWERS I HAVE GIVEN ARE CORRECT AND THAT I HAVE NOT WITHHELD ANY INFORMATION THAT MAY BE RELEVANT TO MY TREATMENT.
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