New Client Form

New Client Form

  • MM slash DD slash YYYY

PRIVACY POLICY
Thank you for taking the time to fill out this information. Your information will be secured and it will not be shared with any 3rd party/organization without written permission, such as a doctor or attorney you might be working with. It is solely for the purpose of getting some background before we meet and to help you refine your goals. I look forward to our meeting.

Sincerely Yours,
Amanda Shaffie