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Confidential Client Case History and Intake Form Name: Address: Postal Code: Date of Birth:Date: Phone: Email: Referred by:Primary Concerns:Level: 1(hardly notice symptoms) to 10 (symptoms are unbearable)Medications/Remedies/Supplements
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Answer the specific questions related to your case history, including any medical conditions, medications, and allergies you might have.
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It is a document used to collect confidential information about a client's case history and intake.
Legal professionals and counselors are required to file this form.
The form should be completed by providing accurate and detailed information about the client's case history and intake.
The purpose is to gather relevant information to better understand the client's background and case details.
Information such as personal details, medical history, legal issues, and any relevant background information must be reported.
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