MEDICAL HISTORY: Indicate below any significant medical conditions
I understand that the services provided are not a replacement for medical or psychological care and that any information provided is not prescriptive or diagnostic in nature and is for educational purposes only. I also give my permission for JAN SCAGLIA LMT, with whom I am working with, to discuss information pertinent to my condition(s) and treatment, with my other health care providers.
Thank you for submitting! I will be contacting you by phone to review the intake information you've provided and to set up your appointment. Have a wonderful day!
