Client Intake Form

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Name
Address
Please mark all that apply and provide any additional health information that you'd like us to know:
Clear Signature
I grant my practitioner permission to use light touch and the application of weighted forks and/or a crystal on my body. I am aware that I may verbally revoke this permission before or during my session at any point.
Clear Signature
I have provided my information to the best of my knowledge, including pertinent health information.

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