CLIENT INTAKE FORM
CERTIFIED PRACTIONER:
KATHY RUBINO 808-557-0778
PRINT OUT DOCUMENT, COMPLETE AND RETURN VIA MAIL OR RESCAN AND EMAIL TO THE FOLLOWING:
krubino@hawaii.rr.com
or
Kathy Rubino
Biofeedback n Hawaii
76-987 Ae'o St.
Kailua-Kona HI 96740

PHONE: 808-557-0778