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Please fill out the form below and then fill out your release form.  

Intake Form

Please fill out the following confidential intake form.  If you are unsure of anything or have more that you'd like to put on the form we can discuss it during the appointment.
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I prefer the pronouns
Energy LevelEnergy Level
DigestionDigestion
Social SkillsSocial Skills
Fitness LevelFitness Level
EliminationElimination
Attention LevelAttention Level
Sleep OnsetSleep Onset
Confidence LevelConfidence Level
MotivationMotivation
Sleep DurationSleep Duration
Relaxation AbilityRelaxation Ability
Time of day you will do the practice we designe together:
Length of practice I would like:
Location I will practice:
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