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Shockwave / Cold Laser Therapy

Intake Form

Thank you for choosing ForeverYoung!

 

If you have booked a session with us, please take the time to fill out this form the best you can prior to your appointment day. This helps to keep the clinic running smoothly and your appointment on time!

Do you have a family history of? Check all the apply
Current level of negative stress?
How well do you cope with stress?
Current energy level?
Current level of exercise?
Current nutritional intake?

Thanks for submitting! We have received it.

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