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Holistic Detox
client intake form

Personal Information

Human Design Type & Autority

I'd like to know my Human Design type and inner authority. Understanding your Human Design type can provide insights into yourself and assist you in handling detox in your own unique way.
Date and time of birth
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Health History

Indications for Detoxification

General Detox Indications. Please choose anything that is applicable to you. Please make sure to consult with a Healthcare professional directly if you have any health issues (see Disclaimer).

Liver Flush

Liver Flush is an optional procedure that you can undergo during the physical body detox. These symptoms may indicate Liver congestion. Please mark what is applicable to you.

Contraindications to Detox

Please choose anything that is applicable to you
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