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5331 SW Macadam Ave, Ste 105, Portland, OR 97239 T 503 445 7999 F 503 445 7997 ElementWellnessPDX.confidential New Patient Registration Last Name Address Home# Email Date of Birth Employer Work Address Spouses/Partners
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Element Wellness PDX is a wellness center that offers various services such as massage therapy, acupuncture, and yoga classes.
Individuals who have utilized the services at Element Wellness PDX may be required to provide their information for filing purposes.
To fill out the form for Element Wellness PDX, individuals may need to provide their personal information and details about the services they received.
The purpose of the form for Element Wellness PDX is to track and report on the services provided to clients.
Information such as client name, services received, dates of service, and payment details may need to be reported on the form for Element Wellness PDX.
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