A PDF of your completed form will be sent to the email address you provide below.
Please note that you will need to upload a recent (within the last 7 days) fully dressed picture of yourself from the waist up with no one else in the picture, including pets, for Gary to scan while reviewing your intake form. The image must be in either a JPG, PNG or PDF file format and the file size must be smaller than 8 MB. There will be a place to submit this file on the last page of the form. It might be easiest to have this picture file prepared before beginning to fill out the Client Information Form.
Please complete each portion of this form even if the questions seem irrelevant to your situation or to the goals you have for working with Gary. Take your time with filling out the form. The information you provide strengthens the foundation of the work you will be doing with Gary. All information is strictly confidential.
[et_pb_section][et_pb_row][et_pb_column type=”4_4″][et_pb_text]
[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]