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Adéla Krčíková
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Intake form
Help us serve you better
Name
*
Email address
*
What is your main area of interest in therapy?
Please select at least one option.
Traditional Chinese Medicine
Acupressure
Shamanism
Automatic Drawing
Light Language
Osho Cathartic Meditation
Kundalini Energy
Constellation
Third Eye
Chakras
Meridians
Pressure Points
Herbs and Phytotherapy
Aromatherapy
Caviatherapy
Psychosomatics
Mohendžodáro
Have you previously engaged in any form of therapy?
Select
Yes
No
What specific issues or concerns would you like to address?
How did you hear about us?
Select
Friend/Family
Social Media
Website
Event
Advertisement
What is your preferred method of communication?
Select
Email
Phone
In-Person
Video Call
Do you have any medical conditions we should be aware of?
What are your goals for therapy?
Which service or services are you interested in?
Please select at least one option.
Tradiční čínská medicína
Holistický přístup
Šamanismus
Additional questions or comments
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