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HEALTH & WELLNESS GOALS

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What are your primary wellness goals?

Stress management
Physical fitness
Emotional balance
Improved sleep
Nutritional guidance
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SERVICE PREFERENCES

Which services are you most interested in? (Check all that apply):

Holistic wellness consult
Reiki (Energy Therapy)
Custom herbal formula
Guided meditation
Herbal remedy guidance only
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Preferred Appointment Time:

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HEALTH HISTORY

Do you have any medical conditions or injuries we should be aware of?

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Are you currently on any medications or treatments that may affect your wellness plan?

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Is there anything else you’d like us to know about you or your wellness journey?

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