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About Bri
Theory
Membership
Sessions
Blog
Contact
Cart
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About Bri
Theory
Membership
Sessions
Blog
Contact
Intake Form
Name
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First Name
Last Name
Email Address
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Phone Number
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Date of Birth
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Relationship Status
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Where do you currently live?
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Children?
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Marital Status?
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Occupation?
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Please list any major health concerns:
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Health Goals:
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At what point in your life did you feel your best?
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Any allergies/sensitivities?
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How is your sleep?
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Do you take any supplements?
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Have you been on or are you on any specific diets?
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Was there a time in your life you were diagnosed with an EDO?
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Any healers or therapies involved in your past/current life?
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What role does physical activity play in your life?
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Please share any additional information you’d like or that would be helpful for me to know prior to our sessions:
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Thank you!
