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Client Intake Form

Please fill out the following form
in order to participate in our activity.

Logo of Body and Soul Remedy, a trusted provider of holistic therapies for pain relief, rejuvenation, and well-being

Please indicate any of the following health conditions you may have:

Check all that apply
Have you been hospitalized in the last 12 months?
Have you had professional bodywork before?

Thanks for submitting!

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