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                                   Caim Wellness Center and Spa

CLIENT INTAKE FORM

Areas of Concern:*
Are you currently using any Retinols or Retin A products
Are you currently under the supervision of a doctor?*
Have you been Diagnosed with Cancer?*
Have you had any injectables?
Are you currently pregnant?
Services Requested:
Are you using a tanning bed?
Are you taking medication?
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