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New Clients Form / Neukunden Formular
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Email
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Your email
First Name / Vorname
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Last Name / Nachname
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Street / Strasse
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House No / Hausnummer
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Postal Code / Postleitzahl
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City / Stadt
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Country / Land
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Your focus, needs and goals and area of pain. /
Deine Schwerpunkte, Bedarfe und Ziele und was dich am meisten schmerzt.
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I would like to invest in the following session package. Invoicing is done separately after each session / Ich möchte in das folgende Sitzungs-Paket investieren. Die Abrechnung geschieht separat nach Sitzung.
3+1 Sessions / Sitzungen, 375 EUR
7+1 Sessions / Sitzungen, 875 EUR
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Are you currently taking medication and are in other forms of treatment ? Please share. / Nimmst du momentan Medikamente und/oder bist in anderweitiger Behandlung? Bitte teile mit mir diese Informationen.
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Privacy Policy
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Link zur Datenschutzerklärung
Ja, ich habe die Informationen gelesen und verstanden
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AGB
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Link zu den AGBs
Ich habe die AGBs gelesen und zur Kenntnis genommen
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