Lucid Living Yoni Steam Intake Form
Please answer with complete honesty. An accurate and complete womb synopsis will best assist in creating and utilizing the most appropriate Hydrotherapy Peristeam protocols for your situation. Any information received in this Intake Form and during steaming sessions is treated with complete confidentiality.
Email address *
First and Last Name *
Your answer
Mailing Address (street, city, state, and zip code) *
Your answer
Phone Number *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Emergency Contact (name, phone number, address, and email) *
Your answer
Are you currently pregnant, may be pregnant, or actively trying to conceive? *
Do you currently have an Intra-Uterine Device (IUD) *
Are you currently on your menstrual cycle? *
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