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RePatterned
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Intake form
Help us serve you better
Name
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Email address
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What brings you to RePatterned?
Please select at least one option.
Chronic stress
Trauma
Seeking deeper healing
Interest in sound therapy
Have you previously experienced any type of healing or therapeutic modalities?
Please select at least one option.
Sound therapy
Biofield tuning
Vibroacoustic therapy
Meditation
What specific areas would you like to focus on during your session?
Do you have any known sensitivities or conditions that we should be aware of?
How did you hear about RePatterned?
Select
Friend or family
Social media
Online search
Event or workshop
What is your preferred method of contact?
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Email
Phone
Text message
Are you currently taking any medications or undergoing treatment?
What are your expectations for this healing experience?
Which service or services are you interested in?
Please select at least one option.
<strong>Biofield Tuning Session</strong>
<strong>Vibroacoustic Therapy Session</strong>
<strong>Signature Repatterning</strong>
Additional questions or comments
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