Waiver
Route 2 Wellness massage therapy event Waiver Forum
Name
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Phone Number
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Address
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City
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State
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Email
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Birthday
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DD
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YYYY
Employer
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Have you ever been to Route 2 Wellness?
Are you currently seeing a Chiropractor?
Do you suffer from any of the following?
If we could help you with your pain or condition, would you want that help?
Would you be interested in attending an educational presentation about any of the following?
By signing below, I give consent for a Route 2 Wellness Employee to provide me with a massage/adjustment.
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