Well of Life Center for Holistic Healthcare

CFT Intake 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 INFORMATION

TRAUMAS/INJURIES:

CHILDBIRTH:

YOUR BIRTH:

CLIENT CONSENT

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.

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