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Client Intake Form

Please note that all fields are required and you must select both check boxes in order to submit your information.

By checking this box and submitting this form, I understand that Adalina East and Entropy Healing, LLC are here for educational purposes only and I hold harmless both entities. Do not discontinue pharmaceuticals without consulting with your medical doctor first.

If I cancel my appointment with less than 48 hours' notice, I will be charged for a full session.

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