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Intake Form
Your Name and Contact Details
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Emergency Contact
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Any mental/physical health conditions I should know about?
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Current Medications?
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Comfortable with light therapeutic touch?
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Comfortable with light therapeutic touch?
A
Yes
B
No
C
Depends
Consent
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Consent
I understand this may bring up intense emotions and I consent
I'm willing to feel uncomfortable sensations as part of healing
I commit to communicating my boundaries during session
I understand this isn't a replacement for medical/psychiatric treatment
Is there anything else you think i should know?
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Submit
