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Client Intake Form
Welcome! Fill me in with your holistic background and goals for working together.
This will serve for the foundation of our sessions together and will save us time in our initial session.
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* Indicates required question
Email
*
Your email
full name
*
Your answer
any nickname you prefer to go by. if any :)
Your answer
preferred pronouns
*
she/her
he/him
they/them
Other:
Required
date of birth
*
MM
/
DD
/
YYYY
location (city)
*
Your answer
I'm looking for an
*
in-person session in Montreal
a remote session
either/or
Other:
Required
how did you hear about me?
*
Your answer
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