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CLIENT INTAKE FORM

Thank you for reaching out to Mindful Solutions North.
Please complete the form below. Your information will remain confidential and will help me better understand your needs before we connect. Once your form has been reviewed, I'll contact you to discuss the next steps and schedule your appointment.

Please note: This form is intended for appointment requests and general inquiries only. If you are experiencing a mental health crisis or require immediate assistance, please call 911 or visit your nearest emergency department.

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