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Health Declaration

Please fill out the following form
in order to book a session. 

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?
If You checked The box above please Answer
If you checked the box above please answer
Respiratory Issues
Skin Issues
Head & Neck Issuses
Infections Conditions
Reproductive Issues
Family History
Neurolgical Issues

Thanks for submitting!

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