Mindfulness for Health Individual Intake Form

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Mindfulness for Health follows the strict PHIPA and HIPAA compliance requirements for information collection and storage.

The information you provide in this intake form is kept confidential and will only be reviewed by your Psychotherapist, Angie Kingma

The Intake Form will take 10-15 minutes to complete. Please click "NEXT" to continue:
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This form was created inside of Mindfulness For Health.