Client Intake Form

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Do You Have Private Health Insurance?

Do You Have Any Of The Following?
High Blood PressureBreathing DifficultiesDiagnosed Medical Health ConditionDiagnosed Mental Health ConditionNone of the above

How Did You Find Shamarie ?
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If you have filled in this form before making your first appointment I will contact you shortly

thanks for your interesting in making an appointment with me. I will be my pleasure to help you achieve greater wellbeing and peace of mind.