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SHIATSU INTAKE FORM

ADDRESS:

DESIRED APPOINTMENT LENGTH:

* Discuss rates and appointment availability prior to submitting form.

HEALTH INFORMATION:

Choose all that apply to you:
Choose all that apply to you:
Choose all that apply to you:
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To be completed prior to appointment.  Mark areas with "xxx" that desire attention.

APPPOINTMENT / CREDIT CARD DEPOSIT:

* To confirm appointment, we require 50% deposit at time of booking.  E-transfers are accepted as well at: info@SatoriWellnessStudio.com

Thanks for submitting!

CLIENT INFORMATION:

CLINICAL INFORMATION:

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