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FINAL Evergreen Holistic w description P

Call (941) 423-5409
SERVICES AVAILABLE 7 DAYS A WEEK

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Client Intake Form - Therapeutic Massage/Bodywork

The following information will be used to help plan safe and effective massage sessions. Please answer the questions to the best of your knowledge.

Personal Information:

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

Are you experiencing any flu symptoms?

No

Yes

Date

Initials

I confirm that the information given in this form is true

Phone

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WellnessLiving Login

General Terms & Conditions

Cancellation Policy

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Wellness Appointment Hours:
Monday - Saturday: By appointment only

Sunday: Closed for appointments

View the Class Schedule

*Classes are available 7 days/week

Location
2525 Bobcat Village Center Rd
Unit 104
North Port, FL 34288
(941) 423-5409

Est. License: #MM40752

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