4 Accountability Screening Form
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Last Name
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First Name
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Primary Email
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City
Do you have any persistent symptoms you struggle with?
What results are you looking for?
Do you have any obstacles preventing you from reaching your health goals?
What did you find valuable from the last time we worked together?
This is what I want to talk about ...
Make an Appointment: You will be able to choose from available Appointments on the next step
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