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Conscious Consulting and Counseling, Inc

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SHINE

Conscious Consulting and Counseling, Inc a 501©3 organization

Client Information

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Last Name

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I hereby give consent to SHINE: Conscious Consulting and Counseling, Inc to provide clinical and/or prevanative mental health services:

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Are you currently suffering from a medical condition, illness, or injury?

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Yes

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Conscious Consulting and Counseling, Inc

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Consciously Created by Tara McCallam @2021

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