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Intake Forms

NEW CLIENTS

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New Client Intake Form

BE INTENTIONALLY WELL

New client intake forms need to filled before your first Cold Laser Detox session, BrainTap, and/or Intuitive Guidance Consultation. This form will take approximately 10 minutes to complete & must be completed in one sitting.

        

Our intake form can be filled out online via a secure platform so you do not need to print it. Intake forms only need to filled out once unless your personal information has changed.

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Just click the button below:

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© 2020 Be Intentionally Well | All Rights Reserved

Disclaimer:  Please note that low level laser therapy does not work for every person. These systems are not intended to diagnose, treat, cure, mitigate or prevent disease. We recommend consulting with your physician or health care professional if you have a disease, medical condition, or concerned about a health-related issue. CLD and the statements on this site have not been evaluated by the Food & Drug Administration and make no claims to cure any illness, disease, or ailment.  The information provided on this site is for education purposes only and not intended to act as a substitute for medical counseling.​

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