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General Intake 2

Personal Info
Contact Info
Emergency Contact
Other
Medical Info
Conditions
Energy Level
Treatment Goals
TMJ (Jaw)
Feet
Energy
Well Being
Emotion / Memory
Female Health
Area of Complaint
Headaches
Musculoskeletal
Skin
Neurological
Cardiovascular
Endocrine
Miscellaneous
Massage Goals
Which best describes what you are experiencing
Allergy
Emotion / Mood
Review, Accept and Sign