CFT Intake Form Please enable JavaScript in your browser to complete this form.New Client Appointment Checklist: 1. Fill out paperwork completely, 2. Drink plenty of water prior to your session, 3. No makeup, perfume, lotions or, deodorants, 4. Eat 2 hours prior to appointment.CLIENT INFORMATIONName *FirstMiddleLastHome Phone Number *Cell Phone NumberAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Birthdate *Age *Gender *FemaleMaleMarital Status *Never MarriedMarriedSeparatedDivorcedWidowedTRAUMAS/INJURIES:Please check the traumas that you have experienced. If none, select ‘NONE.’ConcussionChildhood AccidentOrthodonticsBroken BonesFall(s)SurgeriesAuto AccidentDental WorkNONEExplanation/Details:CHILDBIRTH:Select all that apply. If you have not given birth, select N/A.Long LaborEasy birth(s)Vaginal deliveryDifficult birth(s)C-sectionOther issuesN/AExplanation/Details:YOUR BIRTH:Select all that apply.Long LaborVaginal deliveryC-sectionEasy birthDifficult birthOtherissues/complicationsI DON’T KNOWExplanation/Details:CLIENT CONSENTAgreement and Release of Liability *Please click HERE to read our Agreement and Release of Liability. Then, sign by typing your full name in the box above. By signing, you are acknowledging that you have read and accept the terms and conditions of the Agreement and Release of Liability.CommentSubmit