Whole Spirit Riverdale

Client Intake Form

Client Intake Form
Do you prefer calls, texts, or emails?

Privacy Policy:

All of your personal information will be kept private and will never be shared with anyone and will be used solely to help me best support you.  It is your responsibility to share any and all relevant medical information with your healthcare provider.

Do you have a history of miscarriage or stillbirth?
Have you received fertility treatments?
Have you ever had a C-Section?
Have you had any prenatal complications with this pregnancy?
If YES, check all that apply:
Do you have any other medical conditions I should be aware of, including allergies to essential oils or honey?
Are there any pain management or relaxation techniques that you would NOT like to use?
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