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Reconnect: The Somatic Movement Learning Circle 
Program Intake Form

e.g., medication (NSAIDs, muscle relaxers), physical therapy, chiropractic care, massage, yoga, meditation, specific exercises, rest, or heat/ice application.

Medical Imaging and Diagnostic Tests
Yes
No
Availability

Once you submit the form, you’ll be redirected to a Calendly link where you can choose a time for your Intake Call.

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