Client Intake Form

BEFORE YOU BEGIN: 

• The client intake form will take approximately 10 minutes to complete. 
• It is imperitve that you disclose as much information regarding your menstrual, reproductive, sexual and hormonal health to ensure you are provided the best plan for your specific needs.
• All information gathered here will remain private and confidential. No personal information will be shared with anyone without your express permission. Exceptions may be made if there is an imminent threat of serious injury to oneself or someone else. 
• We engage with medical, allied, and complementary and alternative health professionals and may refer you to other professionals if we deem prudent, only after gaining your express permission to do so.
• Please read our Privacy Policy for more information.