RTW New Client Registration Form

Please correct the errors described below.
How would you like us to refer to you?
your direct or personal phone number
Generally for correspondence and video Telehealth links
Please write, "N/A" if not applicable to you
Email or text a picture of the front and back of your insurance card to admin@rinkertherapyandwellness.com or text 253-350-8763
Is there anything we can change about this form to best meet your needs?

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