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  • Below is the intake form that you fill out on your web browser

  • The treatment plan costs $82 which is payable on completion by paypal

  • It is your responsibility that all information is entered honestly and accurately

  • All information collected is STRICTLY CONFIDENTIAL

  • Most fields are voluntary, however more information helps us with developing a better overview

  • DONT press the back or refresh page button because you will lose everything you have input

  • There are downloadable forms below that may help

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