Monday, August 21, 2006

Disney Cinemagic Emdirecto Em Portugues



NAME:
DATE OF BIRTH: AGE: ADDRESS
:
PHONE: E-MAIL
HOW DID YOU HEAR OF THIS WORK:

done any THERAPY?
NOW MADE, WHICH?

DESCRIBE THE SYMPTOMS THAT I TOOK A LOOK AT THIS THERAPY COMEÇNADO SYMPTOM BOTHER YOU THAT MORE AND HOW LONG DOES IT FEEL?






ACOMPANHMENTO HAVE MEDICAL
MAKE PERIODIC EXAMINATIONS? USA TODAY

ANY MEDICATION?

SIGNATURE:

TERP:

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