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Please note that while this form is encrypted, and sent securely to my email, it is NOT HIPAA compliant. No information is shared with any other party. By filling out this form and submitting it, you exempt Kristina Oliver and Heartful Healing, LLC from all liability for any loss of information, though unlikely, that might occur through submission of this form. By providing a phone number, you consent to receive SMS notifications. If you do not agree to these terms and conditions, please contact me directly at the email or phone number listed. Thank you.

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