Intake Form

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(or Parent/Guardian if client is under 18)
Permission To Use Data: By signing below, you give permission to share your case in a database exclusive to Certified Biofield Tuning practitioners for educational and research purposes. (For example: if Biofield Tuning successfully resolved your ailment, the practitioner’s process and protocol, as well as the outcome of the treatment would be shared with other practitioners for their reference). Your identity and personal information will remain anonymous and confidential at all times.
(or Parent/Guardian if client is under 18)
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