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3301 Johnson Street Hollywood, FL 33021 9549876988 6609 Boynton Beach Boulevard Boynton Beach, FL 33437 5617322448 www.flacupuncture.com PLEASE PRINT First Name MI Last Name Male Female Marital Status
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Individuals seeking our services, such as counseling, therapy, or legal assistance, may be required to fill out our intake form.
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Patients visiting our medical or healthcare facility for the first time may also need to complete our intake form to provide necessary information for their treatment.
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Clients looking to hire our services or professionals may be asked to fill out our intake form to gather relevant details and assess their needs.
Remember, the intake form is designed to gather essential information that will help us better understand your situation and provide you with the appropriate assistance or services.
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What is our intake form?
Our intake form is a document used to collect information about new clients or cases.
Who is required to file our intake form?
All new clients or cases are required to fill out our intake form.
How to fill out our intake form?
Our intake form can be filled out online or in person at our office.
What is the purpose of our intake form?
The purpose of our intake form is to gather necessary information to provide appropriate services.
What information must be reported on our intake form?
The intake form typically requires personal information, contact details, and details about the case or reason for seeking services.
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