Your Practitioner has requested that you complete the following self-assessment. Results will be sent directly to the practitioner chosen. Please schedule a follow-up appointment to discuss results or request a copy.

Any information you provide is confidential and will not be shared without your written permission.

If you require results to be sent to another practitoner, you can complete and Submit the
'Authority to Disclose Information' form

Clinical Indication: Body Anxiety

  • Please select the practitioner who requested you complete this assessment.
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