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Roots of Rhythm
New Client Consent Form
First name
*
Last name
*
Birthday
*
Month
Month
Day
Year
Email
Phone
*
Address
Have you received Craniosacral therapy in the past and what was your experience?
Please provide brief medical/mental health history, including medications and supplements that you take.
*
Contraindications: severe bleeding disorders, aneurysms, or recent traumatic head injuries should not use CST. Do you have any contraindications to receiving CST? Have you had surgery in the last 12 weeks?
*
I consent to treatment. Signature:
*
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Post Session Form
First name
*
Last name
*
Phone
Email
Session follow up:
Submit
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